布托啡诺联合帕瑞昔布对瑞芬太尼诱发痛觉过敏的效果

The effect of parecoxib combined with butorphanol on prevention of remifetanil induced hyperalgesia

目的:观察布托啡诺联合帕瑞昔布用于瑞芬太尼复合麻醉患者术后痛觉过敏的效果。方法:择期腹腔镜全子宫切除手术患者60例,随机均分为三组(n=20):PB组术前30 min静脉滴注帕瑞昔布40 mg和手术结束前30 min静脉滴注布托啡诺10μg/kg;P组术前30 min静脉滴注帕瑞昔布40 mg;C组注射等容量生理盐水。记录瑞芬太尼用量、苏醒时间、拔管时间。观察术后30 min时静态、动态切口疼痛视觉模拟评分(visual analogue scale,VAS),术后镇痛的辅助措施采用静脉注射布托啡诺10μg/kg,维持VAS评分<5分。观察术后1 h(T1)、2 h(T2)、6 h(T3)、12 h(T4)Ramsay镇静评分。记录布托啡诺使用情况,不良反应和患者满意率。结果:三组患者一般资料、瑞芬太尼用量、苏醒时间、拔管时间和不良反应差异均无统计学意义(P>0.05)。与C组比较,P、PB组术后30 min时静态和动态VAS评分降低,差异有统计学意义(P<0.05)。与P组比较,PB组术后30 min时静态和动态VAS评分降低(P<0.05)。术后30 min C组有6例,P组有2例使用布托啡诺。与C、P组比较,PB组T1-T2时Ramsay镇静评分升高,患者满意率明显提高,差异有统计学意义(P<0.05)。结论:术前30 min静脉滴注帕瑞昔布40 mg和手术结束前30 min静脉滴注布托啡诺10μg/kg能预防瑞芬太尼麻醉术后痛觉过敏的发生,效果优于单一用药。

Objective To investigate effects of parecoxib combined with butorphanol on prevention of remifetanil - induced hyperalgesiain patients undergoing laparoscopic hysterectomy. Method Sixty ASA I or II patients undergoing laparoscopic hysterectomywere randomly divided into 3 groups (n =20). Group PB received iv injection of parecoxib 40 mg 30 min before surgery and butorphanol10 |jig/kg 30 min before the end of surgery, group P received parecoxib 40 mg 30 min before surgery, group C received salineat the same time. The remifentanil doses, consciousness recovery and extubation time were recorded. At 30 min after surgery,visual analogue scale(VAS) was used to assess the degree of incision pain at rest and during activity,butorphanol 10 jjig/kg was injectedafter surgery if needed. VAS scores were maintained <5. The use of butorphanol, adverse reactions and the rate of patients,satisfaction after surgery were recorded. Results The general information, remifentanil doses, adverse reactions, consciousness recoveryand extubation time were not statistically significant among 3 groups (P >0. 05). Compared with group C,VAS scores at restand during activity were significantly decreased at 30 min after surgery in group P~,PB (P <0. 05). Compared with group P, VASscores at rest and during activity were significantly decreased at 30 min after surgery in group PB (P < 0. 05 ). There were six patientsand two that used butorphanol in group C and P respectively. Compared with group C~,P, Ramsay scores at T1 - T2 and therate of patients were increased in group PB, the difference was statistically significant (P < 0. 05). Conclusion Intravenous parecoxib40 mg 30 min before surgery and butorphanol 10 jjig/kg 30 min before the end of surgery can prevent remifetanil - induced hyperalgesiain patients undergoing laparoscopic hysterectomy, it is better than single drug.