摘要
目的探讨术中输注不同剂量瑞芬太尼对子宫切除术后病人吗啡用量的影响。方法择期行开腹子宫切除术病人40例，随机分为2组（n=20）：小剂量瑞芬太尼组（S组）和大剂量瑞芬太尼组（L组）。麻醉诱导后S组、L组分别以0．1、0．3μg·kg^-1·min^-1速率静脉输注瑞芬太尼，同时靶控输注异丙酚。2组在手术结束前30min均静脉注射吗啡0．15mg／kg。术后送麻醉后恢复室（PACU），停留2h后送回病房。如果VAS评分大于3分，静脉注射吗啡2mg。当VAS评分≤3分后，行病人自控静脉镇痛（PCIA）。记录病人VAS评分大于3分时间（从麻醉停药至术后第1次VAS评分超过3分的时间）、第1次大于3分的VAS评分、静脉注射吗啡后VAS评分≤3分时间、PACU中静脉吗啡用量、术后2h内吗啡总用量。术后24h内每隔4小时记录一次吗啡用量和VAS评分。结果与S组比较，L组术中异丙酚用量较少，VAS评分大于3分时间、术后第1次大于3分的VAS评分、术后各时点VAS评分（均在3分左右）差异无统计学意义（P〉0．05），静脉注射吗啡后VAS评分≤3分时间延长，静脉吗啡用量和术后2h内吗啡总用量增加，术后16—24hPCIA吗啡用量较高（P〈0．05）。结论术中输注瑞芬太尼0．3μg·kg^-1·min^-1使子宫切除术后病人早期需要更大剂量的吗啡来缓解疼痛，静脉注射吗啡后疼痛缓解所需的时间更长，并且术后16—24hPCIA吗啡用量更大，这可能与急性阿片类药物耐受及延迟的痛觉过敏有关。
Objective To investigate the influence of different doses of intraoperative remifentanil on postoperative morphine consumption. Methods Forty ASA Ⅰ or Ⅱ female patients aged 35-60 yr weighing 50-75 kg undergoing elective abdominal hysterectomy were included in this prospective, double-blind, randomized study. The patients were randomly divided into small-dose and large-dose remifentanil groups （ n = 20 each） receiving continuous IV infusion of remifentanil at 0. 1 or 0. 3μg·kg^-1·min^-1 during maintenance of anesthesia. Anesthesia was induced with IV remifentanil infusion （0.3 μg·kg^-1·min^-1 ） and TCI of propofol （target plasma concentration 4 μg/ml）. Tracheal intubation was facilitated with rocuronium 0.6 mg/kg. The patients were mechanically ventilated （VT 8-12 ml/kg, RR 10 bpm, O2 ：air 1：1）. PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with TCI of propofol and continuous infusion of remifentanil at 0. 1 or 0. 3 μg·kg^-1·min^-1. The changes in BP and HR were maintained within 20% of baseline values during operation. Morphine 0. 15 mg/kg was given intravenously 30 min before the end of surgery. The patients were placed in PACU for 2 h after operation and then transported to the ward. All patients received intravenous PCA with morphine （bolus dose 1 mg, lockout time 5 min, no background infusion） after operation. The following were recorded： （1） the total amount of propofol consumed during anesthesia; （2） the time between the end of operation to the patients＇ first request for morphine; （3） the time between the administration of morphine to VAS≤3; （4） the total amount of morphine consumed during the 2 h stay in PACU; （5） the morphine consumption and （6） the VAS scores recorded every 4 h during the first 24 h after operation. Results There was no significant difference in the time between the end of operation and the first request for morphine between the two groups, but 6 patients in small-dose group did not require morphine in PACU. The dose of morphine needed to decrease the VAS score to ≤ 3 was significantly larger in large-dose group than in small-dose group （0.25 mg/kg vs 0.11 mg/kg , median; P 〈 0.05）. It took significantly longer time to relieve pain in PACU in large-dose group than in small-dose group （37.50 min vs 15.00 min, P 〈 0.05） . PCA morphine consumption was significantly larger in large-dose group than in small-dose group during the first 16- 24 h after operation （ P 〈 0.05）. Conclusion The patients in large-dose remifentanil group need more morphine after operation and it takes longer time to relieve pain. The data suggest that intraoperative large-dose remifentanil tends to induce acute opioid tolerance and delayed hyperalgesia compared with intraoperative small-dose remifentanil.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第7期594-598,共5页
Chinese Journal of Anesthesiology
关键词
哌啶类
吗啡
镇痛
病人控制
子宫切除术
Piperidines
Morphine
Analgesia, patient-controlled
Hysterectomy
