舒芬太尼预防瑞芬太尼麻醉后早期疼痛的效果研究

目的:探讨舒芬太尼应用在瑞芬太尼麻醉后早期疼痛中的预防效果。方法:将我院接诊的应用瑞芬太尼麻醉的手术患者160例进行研究,按照随机数字法分为2组,各80例,对照组采取芬太尼预防麻醉后早期疼痛,而研究组采取舒芬太尼预防,观察记录两组患者术后2h、4h及24h的VAS评分,以及不良反应发生率、自主呼吸恢复时间、拔管时间、意识恢复时间,并对比分析。结果:研究组术后2h、4h及24h的VAS评分均明显低于对照组(P<0.05),同时两组均有不同程度嗜睡、恶心呕吐、皮肤瘙痒等,但研究组不良反应发生率显著低于对照组(P<0.05)。结论:瑞芬太尼麻醉后早期疼痛采取舒芬太尼预防可取得良好的效果。

Pharmacokinetics of Remifentanil in Chinese Patients Undergoing Elective Surgery

Aim To study the pharmacokinetics of remifentanil in Chinese aduh patients undergoing elective surgery and compare the results with the data already published. Methods The pharmacokinetics of remifentanil was determined in 10 aduh patients undergoing elective surgery. Remifentanil 5 - 6 μg·kg^-1 was administered within 1 min after the induction of anesthesia. One point five millilitre of arterial blood samples were collected at 0 （baseline）, 1,2, 3, 5,7, 10, 15, 20, 25, 30, 45, 60, and 90 min after drug administration. Remifentanil concentration was assayed by HPLC/MS/MS. Resuits The concentration-time course of remifentanil was best described by a two-compartment model. Total clearance （CL = 2. 149 ± 0. 431 L·min^-1） of remifentanil was greater than the normal hepatic blood flow. The distribution half-life （t1/2α） [ 1.56 ± 0. 52 min （0.73 - 2.31 ） ] and the elimination half-life （t1/2β） [22.07 ± 10.30 min （9, 71 -36.07）] were similar with those in previous reports. Volume of distribution （ Vd = 65. 766 ± 29. 100 L） was about two times greater than that reported in previous studies of other ethnics. Conclusion In the present study, the volume of distribution is significantly greater than thai reported in previous studies of other ethnics, indicating that there are some differences in the pharmacokinetics of remifentanil among different ethnics.

Effect of parecoxib on remifentanil-induced hyperalgesia after ambulatory surgery

In previous human studies, pretreatment with parecoxib can effectively relieve hyperalgesia after short-term infusion of remifentanil. In this study, we aim to investigate the effect of parecoxib on hyperalgesia after Short-term infusion of remifentanil in clinical practice. Totally, 120 patients who underwent ambulatory surgery were randomly divided into four groups. All patients received either parecoxib （40 mg） or normal saline （as placebo） 30 min before induction of anesthesia. Group A （placebo ＋ propofol） and Group B （parecoxib ＋ propofol） received only propofol for anesthesia, while Group C （placebo ＋ propofol ＋ remifentanil） and Group D （parecoxib ＋ propofol ＋ remifentanil） received both propofol and remifentanil for anesthesia. Visual analogue score （VAS） was used to evaluate pain score at various time points, including the time of birth date recollection and 30, 60, 90, 120, 180, 240, and 300 min after surgery, respectively. During the phase from discontinuation of anesthesia to 240 min after surgery, there is significant difference in the severity of pain among four groups with the order of： Group B 〈Group A 〈Group D 〈Group C （P〈0.001）. Compared with patients in Groups A and B, patients in Group C suffered significantly higher pain score. After admini- stration of parecoxib, patients in Groups B and D experienced similar low pain score with comparison to Groups A and C （P〈0.001）. Patients in Groups B and D experienced shorter recovery time to eye opening on verbal command and recollection of birth date among the four groups （P〈0.001）. Groups B and D also had significantly improved satisfaction of pain management （P〈0.001）. In conclusion, short-term infusion of remifentanil can induce significant hyperalgesia in clinical practice, while pretreatment with parecoxib at 40 mg is effective in relieving such remifentani-induced hyperalgesia. In addition, we also found that pretreatment with parecoxib could significantly improve patients＇ satisfaction of pain management.