摘要目的 探讨小剂量舒芬太尼联合帕瑞昔布钠对瑞芬太尼麻醉后术后痛觉过敏的预防效应.方法 将120例择期全麻下行腹部手术患者按随机数字表法分为三组,术中均给予瑞芬太尼静脉输注,术毕前30 min A组静脉注射舒芬太尼0.1μg/kg,B组静脉注射舒芬太尼0.2μg/kg,两组均联用40 mg帕瑞昔布钠,C组注射生理盐水5 ml.比较三组患者术后苏醒时间、拔管时间、术后1、2、6、12、24h视觉模拟评分法(VAS)评分以及术后24h追加镇痛药物例数与发生躁动情况.结果 B组苏醒时间与拔管时间明显长于A组和C组[(10.9±1.3)min vs (8.6 ±0.6)min、(8.2±0.7) min;(14.0±2.1)min vs(10.7 ±2.2)min、(10.8±1.2)min,P均＜0.01];各时点A组、B组VAS评分均明显低于C组(P＜0.01);C组术后24 h追加镇痛药物例数、发生躁动例数明显多于A组、B组(P＜0.01),A组术后24h追加镇痛药物例数、发生躁动例数多于B组,但差异无统计学意义(P＞0.05).结论 小剂量舒芬太尼联合帕瑞昔布钠可有效抑制瑞芬太尼麻醉后诱发的疼痛过敏,且不会出现苏醒时间及拔管时间延迟现象,安全性高.

abstractsObjective To explore preventive effect of low-dose sufentanil combined with parecoxib sodium for hyperalgesia of remifentanil anesthesia after postoperative.Methods A total of 120 patients undergoing elective abdominal surgery under general anesthesia was randomly divided into three groups that were given intraoperative remifentanil infusion.At the 30 minutes before surgery,group A were given intravenous sufentanil 0.1 μg/kg combined with 40 mg parecoxib sodium,group B were given intravenous sufentanil 0.2 μg/kg combined with 40 mg parecoxib sodium,and group C were given normal saline 5 ml.Postoperative recovery time,extubation time,postoperative 1,2,6,12,and 24 h visual analog scale (Visual Analogue Scale/Score,VAS) score,and after 24 h additional analgesia number of cases and the restless occurrence of three groups were compared.Results Awakening time and extubation time of group B was significantly longer than groups A and C [(10.9 ± 1.3) min vs (8.6 ± 0.6) min,(8.2 ± 0.7) min;(14.0 ± 2.1) min vs (10.7 ± 2.2) min,(10.8 ± 1.2) min,all P ＜ 0.01].Each point VAS scores of groups A and B were significantly lower than group C (P ＜0.01).After 24 h,the number of cases additional analgesic medication,and restlessness occurrence of group C were significantly more than the number of cases of groups A and B (P ＜ 0.01),the number of cases and the restless occurrence after 24 h additional analgesic drugs of group A were more than group B,but there was no significant difference between two groups (P ＞ 0.05).Conclusions Low dose sufentanil together with parecoxib sodium can inhibit after-remifentanil-induced hyperalgesia,and will not appear awakening time and extubation time delays and safe.