地佐辛和羟考酮预防瑞芬太尼引起痛觉过敏的临床研究

Effects of dezocine and oxycodone on remifentanil-induced hyperaigesia

目的 比较地佐辛和羟考酮对妇科腔镜手术中瑞芬太尼引起的痛觉过敏的预防作用.方法 选择全身麻醉下行妇科腹腔镜手术患者48例,年龄18～60岁,ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为3组：对照组、地佐辛组和羟考酮组,每组16例.地佐辛组和羟考酮组在手术开始前15 min分别给予0.09 mg/kg的地佐辛和羟考酮,对照组给予等量生理盐水.麻醉诱导,3组患者均给予咪达唑仑注射液0.02 mg/kg、依托咪酯0.3 mg/kg、顺式阿曲库铵0.2 mg/kg、瑞芬太尼1μg/kg,之后置入一次性使用双腔喉罩,机械通气.术中维持BIS值在40～60,并且根据BIS值调节丙泊酚输注速度,瑞芬太尼以0.2μg·kg-1·min-1恒速输注至手术结束.分别记录手术时间、麻醉时间、术中丙泊酚和瑞芬太尼的使用剂量、术后疼痛VAS评分、术后Ramsay镇静评分、手术前后热痛阈值及术后1h内恶心、呕吐、寒战等并发症的发生率.结果 与对照组比较,地佐辛组和羟考酮组术后疼痛VAS评分均明显降低（P〈0.05）.单纯应用瑞芬太尼导致患者出现痛觉过敏,术后热痛阈值明显低于术前热痛阈值（P〈0.05）;预先给予地佐辛组的术前术后热痛阈值为（44.3±1.9）℃和（44.4±2.5）℃,羟考酮组为（43.7±1.7）℃和（43.7±1.9）℃,两组术前术后热痛阈值比较差异无统计学意义（P〉0.05）.与对照组比较,地佐辛组术后寒战发生概率明显降低（P〈0.05）.3组间手术时间、麻醉时间、丙泊酚和瑞芬太尼的使用剂量、Ramsay镇静评分及恶心、呕吐差异均无统计学意义（P〉0.05）.结论 地佐辛和羟考酮能明显预防瑞芬太尼引起的痛觉过敏,并且能够改善患者术后疼痛.地佐辛能降低术后寒战发生率.

Objective To evaluate the effects of dezocine and oxycodone in preventing remifentanil-induced hyperalgesia. Methods Forty-eight patients undergoing laparoscopic gynecological surgery under general anesthesia were randomly divided into three groups （16 patients in each group） , respectively received treatment with dezocine （group D） or oxycodone （group O）, or without treatment （group C）. Fifteen minutes before the operation, patients in group D and group O were respectively injected intravenously with dezocine 0.09 mg/kg and oxycodone 0.09 mg/kg, respectively, while the equal volume of normal saline was administered in group C. Anesthesia was induced with a combination of 0.02 mg/kg midazolam, 0.3 mg/kg etomidate, 0.2 mg/kg cisatracurium, and 1 μg/kg remifentanil. Then, the patients were ventilated with laryngeal mask airway. During the operation, BIS in electroencephalography was maintained between 40 to 60 by adjusting the dosage of propofol. Remifentanil was injected at the speed of 0.2 μg·kg-1·min-1. After surgery, VAS score and Ramsay score were also calculated, and adverse effects, such as nausea, vomiting, and shivering were recorded. The thermal pain threshold was measured before and after surgery. Results Compared with the group C, the postoperative VAS scores were significantly decreased in both group D and group O （P〈0.05）. Although thermal pain threshold in three groups were at the same levels before surgery, it was significantly reduced after surgery in group C, instead of in group D and group O. Additionally, patients in group D and group O exhibited less incidence of postoperative shivering （P〉0.05）. Conclusions Dezocine and oxycodone were both effective in preventing remifentanil-induced thermal hyperalgesia, and dezocine can cut down the incidence of shivering.