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| 手术末期瑞芬太尼逐级撤药可以减轻颈椎手术患者术后痛觉过敏 |
| Gradual withdrawal of remifentanil in the end of operation may prevent postoperative hyperalgesia in patients undergoing cervical spine surgery |
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| DOI：10.12089/jca.2019.03.007 |
| 中文关键词: 逐级撤药 瑞芬太尼 痛觉过敏 全身麻醉 |
| 英文关键词: Gradual withdrawal Remifentanil Hyperalgesia General anesthesia |
| 基金项目:2016河北省政府资助临床优秀人才培养和基础课题研究项目（361005） |
| 作者 | 单位 | E-mail | | 景栋昆 | 400038,重庆市,陆军军医大学第一附属医院手术麻醉科 | | | 杨智勇 | 400038,重庆市,陆军军医大学第一附属医院手术麻醉科 | | | 吕锐 | 400038,重庆市,陆军军医大学第一附属医院手术麻醉科 | | | 曹剑 | 400038,重庆市,陆军军医大学第一附属医院手术麻醉科 | | | 顾健腾 | 400038,重庆市,陆军军医大学第一附属医院手术麻醉科 | | | 鲁开智 | 400038,重庆市,陆军军医大学第一附属医院手术麻醉科 | | | 易斌 | 400038,重庆市,陆军军医大学第一附属医院手术麻醉科 | yibin1974@163.com |
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| 中文摘要: |
目的 观察手术末期瑞芬太尼逐级撤药减轻骨科手术患者术后痛觉过敏的效果。
方法 选择2017年3至12月在本院择期行颈椎手术的患者80例，男45例，女35例，年龄20～55岁，BMI 18.5～24 kg/m2，ASA Ⅱ 或 Ⅲ 级。按照随机数字表法将患者分为逐级撤药组（G组）和立即撤药组（A组），每组40例。患者入室后进行常规监测，所有患者均行静脉麻醉，静脉泵注丙泊酚6～8 mg·kg-1·h-1和瑞芬太尼0.08～0.20 μg·kg-1·min-1，在手术结束时，G组瑞芬太尼持续泵入，每5分钟泵入量减少麻醉维持量的三分之一，于术后15 min停止泵入；A组在术后立即停止瑞芬太尼的泵入。在麻醉诱导前和术后1、2、6、24 h进行机械痛阈值测定，记录术后1、2、6、24 h的VAS评分，以及患者术后0～1、1～2、2～6、6～24 h时段舒芬太尼用量，记录患者术后苏醒时间、意识恢复时间、术后拔管时间以及术后恶心、呕吐、呼吸抑制、低血压和寒战等不良反应的发生情况。
结果 与麻醉诱导前比较，术后1、2 h A组患者机械痛阈值明显降低（P<0.05），G组患者不同时点机械痛阈值差异无统计学意义。术后1、2 h G组患者VAS评分明显低于A组（P<0.05）。术后0～1、1～2 h G组患者舒芬太尼用量明显低于A组（P<0.05），且术后PACU舒芬太尼追加次数明显少于A组（P<0.05）。两组患者术后苏醒时间、意识恢复时间和术后拔管时间差异无统计学意义。G组患者术后恶心呕吐、呼吸抑制的发生率明显低于A组（P<0.05）。两组患者低血压、寒战的发生情况差异无统计学意义。
结论 手术末期瑞芬太尼逐级撤药可以减轻颈椎手术患者术后痛觉过敏，降低患者术后疼痛感，并减少术后恶心呕吐、呼吸抑制的发生。 |
| 英文摘要: |
Objective To investigate the effect of gradual withdrawal of remifentanil on postoperative hyperalgesia in patients undergoing cervical spine surgery.
Methods Eighty patients undergoing elective cervical spine surgery were assigned into two groups according to the table of random number: the gradual withdrawal group (group G) and the abrupt withdrawal group (group A) , including 45 males and 35 females, aged 20 - 55 years, BMI 18.5 - 24 kg/m2, ASA physical status Ⅱ-Ⅲ, 40 cases in each group. The vital signs were monitored and the intravenous anesthesia was performed. All the patients were treated with 0.2 μg·kg-1·min-1 remifentanil and 4 - 12 mg·kg-1·h-1 propofol. At the end of the surgery, anesthesia maintenance of remifentanil in group G gradually reduced by one-third of that during surgery per five minutes and stoped at 15 minutes after surgery. Group A stopped abruptly after surgery. The threshold of mechanical pain was detected before induction and 1, 2, 6 and 24 h after surgery. The VAS score were recorded at 1, 2, 6 and 24 h after surgery and the sufentanil consumption were recorded simultaneously. The awakening time, consciousness recovery time and extubation time of patients were recorded. The adverse reactions such as nausea, vomiting, respiratory inhibition, hypotension and chills after operation were recorded.
Results The mechanical pain thresholds at 1 and 2 h after operation in group A were decreased significantly (P < 0.05), while the mechanical pain thresholds in group G were not significantly changed after surgery. The VAS scores at 1 and 2 h after operation and the postoperative consumption of sufentanil in 0 - 1,1 - 2 h periods after surgery in group G were significantly lower than those in group A (P < 0.05). There was no significant difference in awakening time, consciousness recovery time, postoperative extubation time between two groups. The incidence of nausea and respiratory inhibition was significantly decreased in group G compared with group A.
Conclusion Gradual withdrawal of remifentanil in the end of operation may prevent opioid-induced hyperalgesia in patients undergoing orthopaedic operation，reduce postoperative pain and the incidence of nausea, vomiting and postoperative respiratory depression. |
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