盐酸曲马多、地佐辛、舒芬太尼、盐酸氢吗啡酮防治瑞芬太尼复合麻醉术后超敏痛的效果比较

Effect comparison of Tramadol Hydrochloride,Dezocine,Sufentanil,Hydromorphone Hydrochloride in the prevention and treatment of hypersensitivity pain after Remifentanil combined anesthesia

目的比较盐酸曲马多、地佐辛、舒芬太尼、盐酸氢吗啡酮四种药物在防治瑞芬太尼复合超敏痛中的临床效果。方法选取2015年3月~2017年6月在我院行妇科腹腔镜手术的157例ASAⅠ~Ⅱ级患者作为研究对象,对其临床资料进行回顾性分析,根据手术前所用预防瑞芬太尼痛觉超敏反应药物的不同分为A组(盐酸曲马多,34例)、B组(地佐辛,43例)、C组(舒芬太尼,39例)和D组(盐酸氢吗啡酮,41例)。比较四组患者的苏醒时间和拔管时间,拔管时的心率(HR)和平均动脉压(MAP),术后15 min、1 h、2 h、4 h、8 h、16 h及24 h的VAS评分和Ramsay镇静评分以及术后拔管期间及术后24 h内的不良反应发生情况。结果 D组的苏醒时间和拔管时间明显短于A组、B组和C组(P<0.05),B组和C组的苏醒时间和拔管时间明显短于A组(P<0.05);B组和C组的苏醒时间和拔管时间比较,差异无统计学意义(P>0.05)。D组患者拔管时的HR和MAP均明显低于A组、B组和C组(P<0.05),B组和C组拔管时的HR和MAP均明显低于A组(P<0.05);B组和C组拔管时的HR和MAP比较,差异无统计学意义(P>0.05)。D组术后2~24 h的VAS评分明显低于A组、B组和C组(P<0.05),B组和C组术后2~24 h的VAS评分明显低于A组(P<0.05);B、C两组术后2~24 h的VAS评分比较,差异无统计学意义(P>0.05)。D组术后15 min^2 h的Ramsay镇静评分明显优于A组、B组和C组(P<0.05),B组和C组术后15 min^2 h的Ramsay镇静评分明显优于A组(P<0.05);B、C两组术后15 min^2 h的Ramsay镇静评分比较,差异无统计学意义(P>0.05)。四组术后拔管期间及术后24 h内的不良反应发生率比较为A组>B组>C组>D组,差异有统计学意义(P<0.05)。结论在防治瑞芬太尼复合麻醉术后的超敏痛方面,盐酸氢吗啡酮效果最为明显,不影响患者的苏醒和拔管时间,同时不良反应发生率也最低,其次为地佐辛和舒芬太尼,两者效果相当,但舒芬太尼的术后不良反应发生率更低,盐酸曲马多的效果最差。

Objective To compare the clinical effect of Tramadol Hydrochloride,Dezocine,Sufentanil,Hydromorphone Hydrochloride in the prevention and treatment of hypersensitivity pain after Remifentanil combined anesthesia.Methods 157 patients with ASA grade [ - 11 who underwent gynecological laparoseopic surgery in our hospital from March 2015 to June 2017 were enrolled in this study,according to the different drugs used before surgery,the patients were divided into group A （Tramadol Hydrochloride,34 cases）,group B （Dezocine,43 cases）,group C （Sufentanil,39 cases） and group D （Hydromorphone Hydrochloride,41 cases）.The recovery time and extubation time,extubation heart rate （HR） and mean arterial pressure （MAP） were compared between the four groups,the VAS scores and Ranmsay sedation scores were compared between the four groups at 15 minutes, l h,2 h,4 h,8 h,16 h and 24 h postoperatively,and the incidence of ad- verse reactions during and after extubation in 24 hours were compared.Results The recovery time and extubation time of group D were significantly shorter than those of group A,group B and group C （P〈0.05）,and those of group B and group C were significantly shorter than those of group A （P〈0.05）,there was no significant difference between the group B and group C in the recovery time and extubation time （P〉0.05）.The HR and MAP of extubation of group D were significantly lower than those of group A,group B and group C （P〈0.05）,the HR and MAP of extubation of group B and group C were also significantly lower than those of group A （P〈0.O5）,and there was no significant difference between the group B and group C in the HR and MAP of extubation （P〉0.05）.The VAS score at 2 hours to 24 hours after opera- tion in group D were significantly lower than those of group A, group B and group C （P〈0.05）,while those of group B and group C were significantly lower than those of group A （P〈0.05）,there was no significant difference between group B and group C in the VAS score at 2 hours to 24 hours after operation （P〉0.05）.The ramsay sedation scores at 15 min- utes to 2 hours after operation in group D were obviously better than those of group A, group B and group C （P〈0.05）, those of group B and group C were obviously better than that of group A （P〈0.05）,there was no significant difference between group B and group C in the ramsay sedation scores at 15 minutes to 2 hours after operation （P〉0.05）.The inci- dence of adverse reactions in the four groups after extubation and postoperative 24 h was group A〉group B〉group C〉 group D,the differences were statistically significant （P〈0.05）.Conclusion In the prevention and treatment of Remifentanil after anesthesia, the effect of Hydromorphone Hydrochloride is the most obvious,it does not affect the recovery and extubation time of the patients,and the incidence of adverse reactions is also the lowest,followed by Dezocine and Sufentanil,both are quite effective,but the adverse effects of Sufentanil postoperative complication rate is lower,and Tramadol Hydrochloride is the worst.