羟考酮或舒芬太尼预防瑞芬太尼诱发的术后痛觉过敏的效果

Compariation of preventive effects of oxycodone or sufentanil on post-operative hyperalgesia induced by remifentail

目的观察羟考酮或舒芬太尼预防瑞芬太尼术后痛觉过敏的作用。方法全身麻醉下行择期胃癌根治术患者120例,男62例,女58例,年龄18~65岁,ASAⅠ或Ⅱ级。将患者随机分为三组:羟考酮组(O组,n=42)、舒芬太尼组(S组,n=40)和生理盐水组(C组,n=38),术毕前分别给予羟考酮10mg、舒芬太尼10μg和等容量生理盐水。评价患者苏醒后静息VAS评分,若VAS≤3分则认为无痛觉过敏现象,>3分为有痛觉过敏,≥6分则静注舒芬太尼,直至VAS评分<6分。记录拔除气管导管即刻(T_1)、术后0.5h(T_2)、1h(T_3)、2h(T_4)和4h(T_5)的BCS舒适度评分,记录患者意识恢复时间、拔管时间及拔管后4h内恶心呕吐的发生情况。结果 T_1~T_5时O组BCS评分明显高于S组和C组(P<0.05)。S组恶心呕吐发生率明显高于O组和C组(P<0.05)。三组意识恢复时间和拔管时间差异均无统计学意义。结论术毕前静注羟考酮10 mg明显预防瑞芬太尼麻醉术后诱发的早期痛觉过敏,同时不影响患者苏醒,亦不增加恶心呕吐的发生率。

Objective To compare the effect of oxycodone or sufentanil in preventing post-operative hyperalgesia induced by remifentanil.Methods One hundred and twenty patients scheduled for radical operation for carcinoma of stomach undergoing general anesthesia,62 males and 58 females,aged 18-65 years,ASA physical statusⅠ orⅡ,were randomly divided into 3groups.Thirty minutes before the end of operation,oxycodone hydrochloride 10 mg was administered intravenously in oxycodone hydrochloride group（group O,n=42）while sufentanil 10μg was injected in group S（group S,n=40）and equal normal saline was injected in control group（group C,n=38）.The VAS score after waking up was recorded.VAS score3was defined as hyperalgesia,and sufentanil was injected when VAS score≥6.The BCS scores were recorded immediately after extubation（T1）,30min（T1）,1h（T3）,2h（T4）and 4h（T5）after extubation.Awakening time and extubation time and the incidence of nausea and vomiting 4hafter extubation were compared.Results At T1-T5,the BCS scores in group O were significantly higher than those in groups S and C（P〈0.05）.Group S has a higher adverse reaction（P〈0.05）.There was no significant differences of awakening time and extubation time in 3groups.Conclusion Prophylactic injection of oxycodone 10 mg can reduce incidence rate of post-operative hyperalgesia,and increase BCS score with little side effects.