术中持续输注小剂量舒芬太尼对丙泊酚联合瑞芬太尼麻醉下患者术后痛觉过敏的效果

摘要

Objective To evaluate the laparoscopic hysterectomy surgery continuous infusion of low-dose sufentanil combined with propofol and remifentanil anesthesia postoperative hyperalgesia influence.Methods Patients were collected from June 2013 to June 2015 in our hospital undergoing laparoscopic hysterectomy 60 cases.According to the principles of randomized, divided into sufentanil group (SF group) and 30 cases of normal saline group (NS group) 30 cases.Two intraoperative remifentanil 0.1-0.2 μg/(kg・ min) and propofol 4-8 mg/(kg・ h) to maintain anesthesia.After the operation began, SF group and NS group were sufentanil and saline.Record calls eyes, recovery of spontaneous breathing, extubation time;after waking 5 min, 30 min, 12 h, 24 h, 48 h pain (visual analogue scales, VAS) score; before induction (T0), after induction (T1), after intubation (T2), surgery (T3), extubation (T4), after extubation 10 min (T5) heart rate (HR) and mean arterial pressure (MAP); excessive sedation, respiratory depression, intraoperative awareness, restless when awake, intraoperative after nausea/vomiting, tramadol and so on.Results SF group and NS group recovery of spontaneous breathing, eye opening and extubation call time was not statistically significant;after SF group wake 5 min, 30 min and 4 h VAS scores lower than the NS group (P <0.05); in T4, T5 point comparison, SF group MAP and HR lower than the NS group (P <0.05); SF group restless when awake, pain (VAS score≥3), postoperative use of tramadol was lower than NS group (P<0.05).Conclusion Intraoperative continuous infusion of low-dose sufentanil improve laparoscopic hysterectomy in patients under anesthesia using propofol combined with remifentanil hyperalgesia, with good prospects for clinical application of anesthesia.%目的：探讨腹腔镜子宫切除术术中持续输注小剂量舒芬太尼对丙泊酚联合瑞芬太尼麻醉下患者术后的痛觉过敏影响。方法纳入2013年6月～2015年6月拟行腹腔镜子宫切除术的患者共60例。根据随机分组的原则，分为舒芬太尼组（ SF组）30例和生理盐水组（ NS组）30例。2组术中输注瑞芬太尼0．1～0．2μg／（ kg・ min）和丙泊酚4～8 mg／（ kg・ h）维持麻醉。手术开始之后，SF组与NS组分别输注舒芬太尼和生理盐水。记录呼唤睁眼、自主呼吸恢复、拔管时间；苏醒后5 min、30 min、12 h、24 h、48 h疼痛（ visual analogue scales，VAS）评分；诱导前（ T0），诱导后（ T1）、插管后（ T2）、术中（ T3）、拔管时（ T4）、拔管后10 min（ T5）心率（ HR）和平均动脉压（ MAP）；过度镇静、呼吸抑制、术中知晓、苏醒时躁动、术后呕心／呕吐、静注曲马多等情况。结果2组呼唤睁眼、拔管时间、自主呼吸恢复的情况均无统计学意义（P＞0．05）；SF组苏醒后5 min、30 min和4 h VAS评分低于NS组（P＜0．05）；在T4、T5时点比较，SF组MAP和HR低于NS组（ P＜0．05）； SF组后使用曲马多发生率、疼痛（ VAS评分≥3）、苏醒时躁动均低于NS组（ P＜0．05）。结论术中持续输注小剂量舒芬太尼可有效改善腹腔镜子宫切除术中采用丙泊酚联合瑞芬太尼麻醉下患者术后的痛觉过敏，具有良好的临床麻醉应用前景。