摘要
目的 评价瑞芬太尼复合麻醉患者术后急性阿片类药物耐受的发生情况。方法 60例择期手术患者随机分为3组（n=20），吸入麻醉组吸入1．3 MAC异氟醚和氧化亚氮维持麻醉;静脉麻醉组靶控输注（TCI）异丙酚（血浆靶浓度3μg／ml）、瑞芬太尼（血浆靶浓度4 ng／ml）维持麻醉;复合麻醉组吸入0．8 MAC异氟醚和氧化亚氮及TCI瑞芬太尼（血浆靶浓度2 ng／ml）维持麻醉。观察术后早期恢复阶段（30 min）患者的疼痛评分及吗啡用量。结果 静脉麻醉组和复合麻醉组在术后早期恢复阶段的疼痛评分及吗啡用量均高于吸入麻醉组（P〈0．05），但2组间比较差异无统计学意义（P〉 0．05）。结论 患者瑞芬太尼复合TCI异丙酚或复合吸入异氟醚麻醉均可导致急性阿片类药物耐受的发生。
Objective To investigate the acute opioids tolerance after remifentanil-based anesthesia in patients. Methods Sixty ASA Ⅰ or Ⅱ patients undergoing elective under general anesthesia were randomly divided into 3 groups （ n = 20 each） ： group Ⅰ inhalational anesthesia; group Ⅱ intravenous anesthesia and group Ⅲ combined inhalational and intravenous anesthesia. In group Ⅰ anesthesia was maintained with 1.3 MAC isoflurane and 60% N2O in O2 ; in group Ⅱ with TCI of propofol （target plasma concentration was set at 3 μg/ml） ＋ TCI of remifentanil （target plasma concentration 4 ng/ml） and in group Ⅲ 0.8 MAC isoflurane ＋ 60% N2O in O2 ＋ TCI of remifentanil （target plasma concentration 2 ng/ml）. The patients were extubated and breathing spontaneously with PETCO2 〈 45 mm Hg and could open eyes on verbal command before being transfered to PACU.Pain was assessed using behavioral pain score （0 = quiet and no pain, 2 = severe pain and complaining） and morphine consumption was recorded during the first 30 min in PACU. Results The pain scores and morphine consumption were significantly higher in group Ⅱ or Ⅲ than in group Ⅰ （P 〈 0.05） during the first 30 min after operation and there was no significant difference between group Ⅱ or Ⅲ Conclusion Remifentanil combined with either propofol or isoflurane induces acute tolerance to opioids in patients.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第5期389-392,共4页
Chinese Journal of Anesthesiology
