术后疼痛高危因素的分析

目的 探讨影响术后疼痛的高危因素,对术后早期疼痛的发生几率及严重程度做出预测.方法 选择本院手术患者2 859例,采用Logistic多项多元回归分析筛选出构成评分系统的影响因素;通过ROC曲线确定预测不同术后疼痛发生率的分值界点;采用Kappa检验比较评分系统预测的术后疼痛发生率与实际疼痛发生率的一致性.结果 Logistic多元回归分析提示:性别、年龄、术前VAS评分、术前焦虑评分、术前心率、手术类型、手术切口大小、麻醉方式、手术时间为影响术后疼痛的高危因素;术后VAS评分的曲线下面积是0.90±0.01(P<0.01);疼痛评分在2.5时,灵敏度为100%,特异度为78.9% ;Kappa指数为0.54.结论 术后疼痛预测模型简单实用,对临床有一定参考价值.     

外周静脉置管疼痛评分与腹腔镜手术后疼痛程度间相关性研究

目的探讨外周静脉置管疼痛评分在腹腔镜术后疼痛中的预测价值,为提高麻醉镇痛效果提供参考依据。方法选取2020年1月至2020年12月期间86例于医院行腹腔镜手术治疗者进行研究。术前将留置针置入患者手背浅表静脉,并采用视觉模拟评分(VAS)法评价患者疼痛程度;术后常规镇痛处理。记录患者术后24小时内静息以及运动时最大疼痛状况。观察并记录患者术后24小时内镇痛泵有效按压次数和不良反应。结果外周静脉置管VAS评分平均为(1.75±0.23)分,术后24小时内静息状态时最大VAS评分为3.52分,活动时为5.93分。24小时内镇痛泵有效按压次数为(1.25±0.14)次。外周静脉置管VAS评分与患者术后24小时内静脉状态、活动时最大VAS评分以及镇痛泵有效按压次数呈正相关性(r=0.57、0.71、0.51,P=0.00、0.00、0.00)。以VAS≥2分为截断点,VAS≥2分患者术后24小时静息状态时发生中重度疼痛比例明显高于VAS2分者,P0.05。研究期间无不良反应发生。结论术前应用外周静脉置管疼痛评分可较好预测腹腔镜术后疼痛程度,从而可指导临床合理镇痛,提高患者术后舒适性,对促进患者快速康复具有重要意义。     

地佐辛在无痛人流术中的应用

目的：评价地佐辛在无痛人流术中的镇痛效果及安全性。方法选择80例ASAⅠ～Ⅱ级要求进行无痛人工流产术的患者，随机分为对照组（单用异丙酚）和地佐辛组（地佐辛复合异丙酚）。在手术过程中连续监测平均动脉压(MAR)、心率(HR)、呼吸(RR)和脉搏血氧饱和度(SpO2)，分别记录清醒后5分钟、0.5小时和3小时的疼痛视觉模拟评分（VAS），同时记录术后不良反应。结果两组患者术中MAR、HR、RR的最低值与术前相比差异有统计学意义(P＜0.05)，两组患者清醒后0.5小时和3小时两个时点疼痛视觉模拟评分（VAS）比较有显著性差异(P<0.05)，异丙酚用药总量比较有显著性差异(P<0.05)，手术时间、苏醒时间及不良反应两组间差异无统计学意义。结论无痛人工流产术术中静脉注射地佐辛能产生充分的镇痛，减少异丙酚的用量，并有良好的人工流产术术后镇痛作用，可安全用于人流术后镇痛。     

经皮球囊扩张椎体后凸成形术疗效分析及技巧

[目的]分析总结经皮球囊扩张椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折的临床疗效,探讨手术技巧.[方法]回顾分析白2008年1月～2010年1月本院PKP术治疗的60例骨质疏松性椎体压缩骨折的病例,经术前、术后1 d、术后6月的定期随访,通过骨折部压叩痛程度对比和疼痛视觉类比评分(VAS),评价临床疗效,并分析总结手术技巧.[结果]所有患者均获定期随访,术前骨折部压叩痛明显、VAS评分为7.85±1.48,术后骨折部位压叩痛明显减轻或消失,VAS评分1.58±0.24,术后6个月随访时骨折部位基本无明显压叩痛,VAS评分为1.03±0.74,采用同一单纯样本t检验对骨折部压叩痛程度指标进行分析,有显著性差异(α=0.05,P<0.01),采用配对t检验对术前、术后1 d、术后6月随访时VAS评分进行统计学分析,有显著性差异(P<0.001).[结论]应用经皮球囊扩张椎体后凸成形术,结合一定的手术技巧,治疗骨质疏松性椎体压缩骨折,可有效缓解患者疼痛,为本病提供一种微创、有明显疗效、安全可靠的治疗方法.     

不同麻醉方式下胃癌根治术后患者疼痛程度的比较

目的 比较不同麻醉方式下胃癌根治术后患者的疼痛程度.方法 择期拟行胃癌根治术患者102例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄50～75岁,体重45～70 ks,采用随机数字表法,将患者随机分为3组(n=34):单纯全麻组(GA组)、全麻联合肋缘下腹横肌平面阻滞组(CGTA组)和全麻联合硬膜外阻滞组(CGEA组).术后拔除气管导管后送至麻醉后恢复室(CPACU),患者入室时记录VAS评分.PACU期间评价疼痛程度,VAS评分＞3分的患者接受静脉吗啡滴定,VAS评分≤3分时停止吗啡滴定,接静脉自控镇痛泵和/或硬膜外镇痛泵.滴定结束时记录吗啡总用量,观察不良反应的发生情况.结果 与GA组和CGTA组比较,CGEA组术后中重度痛发生率降低(P＜0.01);GA组、CGTA组和CGEA组患者术后重度痛发生率、入室时VAS评分及吗啡总用量依次降低(P＜0.01);CGEA组镇静发生率低于GA组(P＜0.01),三组其余不良反应发生率比较差异无统计学意义(P＞0.05).结论 全麻、全麻联合肋缘下腹横肌平面阻滞和全麻联合硬膜外阻滞下胃癌根治术后患者的疼痛程度依次降低.     

延髓头端腹内侧核GABA_A受体在异丙酚致大鼠痛觉过敏中的作用

目的 探讨延髓头端腹内侧核γ-氨基丁酸A亚型(GABA_A)受体在异丙酚致大鼠痛觉过敏中的作用.方法 清洁级SD大鼠64只,雌雄不拘,月龄2～3月,体重250～300 g,随机分为4组(n=16):溶媒对照组(C组)、异丙酚组(P组)、荷包牡丹碱组(B组)及荷包牡丹碱+异丙酚组(BP组).参照脑立体定位图谱定位大鼠延髓头端腹内侧核,C组注射人工脑脊液(荷包牡丹碱溶媒)0.4 μl,5 min后注射二甲基亚砜(异丙酚溶媒)0.4μl,P组注射异丙酚0.4μl(4μg),B组注射荷包牡丹碱0.4μl(10 ng),BP组注射荷包牡丹碱0.4 μl(10 ng),5 min后注射异丙酚0.4 μl(4 μg),各药物均在30 s内注射完毕,30 s后拔针.各取8只大鼠分别进行热板实验和福尔马林实验,记录热痛阈、福尔马林疼痛评分及其第1时相和第2时相累计疼痛评分.结果 热板实验中,P组热痛阈低于C组,BP组给药后20 min时热痛阈明显高于P组(P<0.05或0.01),其余时点差异无统计学意义(P>0.05).福尔马林实验中,P组福尔马林疼痛评分高于C组,BP组各时点福尔马林疼痛评分和第1、2时相累计疼痛评分均明显低于P组(P<0.05或0.01).结论 延髓头端腹内侧核GABA_A受体部分介导了异丙酚致大鼠痛觉过敏作用.     

外周静脉置管疼痛评分与腹腔镜肾切除术患者术后疼痛程度的相关性

目的 探讨外周静脉置管疼痛评分与腹腔镜肾切除术患者术后疼痛程度的相关性。
方法 选择择期行腹腔镜肾切除手术的患者106例,男57例,女49例,年龄18～65岁,BMI 18～28 kg/m²,ASA Ⅰ或 Ⅱ级。术前采用20 G留置针于手背浅表静脉进行置管操作并记录患者对此操作的VAS评分。所有患者于全麻下手术,术后给予舒芬太尼静脉自控镇痛。记录患者术后24 h内静息时最高VAS评分和活动时最高VAS评分,术后24 h内镇痛泵有效按压次数、术后24 h内舒芬太尼的额外消耗量。
结果 外周静脉置管VAS评分与术后24 h内静息时最高VAS评分（r_s=0.64,P＜0.001）、术后24 h内活动时最高VAS评分（r_s=0.65,P＜0.001）、术后24 h内镇痛泵有效按压次数（r_s=0.59,P＜0.001）、术后24 h内舒芬太尼额外消耗量（r_s=0.58,P＜0.001）呈明显正相关。外周静脉置管VAS评分≥2.0分的患者中术后静息时出现中重度疼痛的例数为14例（33.3%）,VAS评分＜2.0分的患者中为8例（12.5%）,VAS评分≥2.0分的患者术后出现中重度疼痛的比例明显高于VAS评分＜2.0分的患者（P＜0.05）。
结论 术前外周静脉置管疼痛评分与腹腔镜肾切除术患者术后疼痛程度具有相关性,外周静脉置管VAS评分≥2.0分患者中术后24 h内静息时出现中重度疼痛比例高于VAS评分＜2.0分患者。     

射频消融辅助上气道手术患者瑞芬太尼、异丙酚联合局部麻醉的效果

目的 评价射频消融辅助上气道手术(CAUP)患者瑞芬太尼、异丙酚联合局部麻醉的效果.方法 拟在局麻下行CAUP手术的中、重度阻塞性睡眠呼吸暂停低通气综合征患者80例,年龄25～60岁,体重指数≤35 kg/m2,ASA Ⅰ或Ⅱ级,随机分为4组(n=20):生理盐水组(S组)、异丙酚组(P组)、瑞芬太尼组(R组)和异丙酚复合瑞芬太尼组(PR组).1%丁卡因咽部表面麻醉后,S组静脉输注生理盐水0.15 ml·kg-1·h-1,P组静脉输注异丙酚25μg·kg-1·min-1,R组静脉输注瑞芬太尼O.05μg·kg·min-1,PR组静脉输注异丙酚25μg·ks-1·min-1和瑞芬太尼0.05μg·kg-1·min-1.10 min后用含1:200 000肾上腺素的利多卡因行术野局部浸润麻醉.术中每5分钟采用Ramsay评分评价镇静程度;采用主诉疼痛分级(VRS)评价疼痛程度.S组VRS分级为Ⅲ级时为麻醉失败,其余3组VRS分级为Ⅲ级时,增加输注速率或静脉注射异丙酚10 mg或瑞芬太尼20μg;如出现Ramsay评分>3分或呼吸抑制(RR<8次/min或SpO2<95%),则为麻醉失败.于射频消融前和射频消融5 min时记录BP和HR.记录气道阻塞和呼吸暂停等不良反应的发生情况.结果 R组、PR组麻醉成功率(分别为90%、100%)高于s组和P组(分别为40%、65%)(P<0.05).与S组比较,射频消融5 min时P组SP、DP和HR差异无统计学意义(P>0.05),R组和PR组SP、DP和HR降低(P<0.05).4组不良反应发生率比较差异无统计学意义(P>O.05).结论 瑞芬太尼和异丙酚复合瑞芬太尼联合局部麻醉可安全、有效地用于患者射频消融辅助上气道手术.     

超激光照射治疗下肢神经病理性疼痛

目的 观察直线偏光近红外线(超激光)照射腰交感神经节,治疗下肢神经病理性疼痛的疗效.方法 采用超激光治疗仪,以L_2为中心对腰交感神经节进行照射,每日1次,每次20 min,连续照射30 d.评价指标为下肢皮肤温度、VAS评分及痛阈.结果 照射后皮肤温度明显高于照射前(P<0.01),治疗后VAS评分明显低于治疗前(P<0.01),治疗后痛阈高于治疗前(P<0.01).结论 超激光照射对下肢神经病理性疼痛有较好的治疗效果.     

术前痛阈和耐痛阈与妇科手术后芬太尼消耗量的关系

目的 评价妇科手术病人术前痛阈、耐痛阈与术后芬太尼消耗量之间的关系.方法 择期全麻下行子宫肌瘤剔除术或子宫全切术病人44例,年龄20～50岁,ASA Ⅰ或Ⅱ级.麻醉诱导前采用电刺激仪测定痛阈和耐痛阈;静脉注射咪达唑仑、瑞芬太尼、异丙酚和琥珀胆碱麻醉诱导;麻醉维持:静脉输注瑞芬太尼和异丙酚,静脉注射阿曲库铵;术后采用芬太尼混合氟哌利多行病人自控静脉镇痛,背景输注速率0.5 ml/h,PCA量2 ml,锁定时间5 min.记录术毕和术后24 h VAS评分、术后24 h镇痛泵有效按压次数和芬太尼消耗量.术前痛阈和耐痛阈与术后镇痛泵有效按压次数和芬太尼消耗量进行直线相关分析.结果 术前痛阈与术后24 h镇痛泵有效按压次数和芬太尼消耗量的相关性无统计学意义(P0.05).术前耐痛阈与术后24 h镇痛泵有效按压次数和芬太尼消耗量呈负相关,r分别为-0.71、-0.70(P<0.05).结论 术前痛阈不能预测妇科手术后芬太尼消耗量,但术前耐痛阈可以预测.     

Pre-incisional administration of ketamine reduced the postoperative pain

This study was designed to examine the postoperative analgesic effect of pre-/post-incisional administration of ketamine. Thirty-nine female patients scheduled for transabdominal hysterectomy were randomly allocated into 3 groups. Patients in group-K1 (n = 13) received intravenous ketamine 100 mg before surgical incision and patients in group-K2 (n = 13) received the same after laparotomy. Group-C (n = 13) did not receive any ketamine. All patients were anesthetized with combined spinal/epidural anesthesia supplemented with sevoflurane 0.5% and nitrous oxide in oxygen. Postoperative pain was controlled by epidural infusion of the mixture of fentanyl (25 mcg.ml-1) and bupivacaine (3.8 mg.ml-1) at 2.1 ml.hr-1. Analgesic effect was assessed by visual analogue scale (VAS) and verbal rating scale (VRS). VAS and VRS in group-K1 were significantly lower compared with those in group-C, while there was no difference between group-K2 and C. The incidence of side effects and additional use of analgesics were similar among the three groups. In conclusion, pre-incisional administration of ketamine reduced the postoperative pain, but post-incisional ketamine was not effective.     

Low-dose propofol reduces the incidence of moderate to severe local pain induced by the main dose

BACKGROUND: Local pain on injection of propofol remains a considerable problem in clinical anaesthesiology. As slow infusion of a low dose of propofol induces little or no pain at the site of injection, and as propofol-induced pain fades during prolonged exposure, this randomized, double-blind, clinical cross-over study was designed to test whether pain on injection of propofol is attenuated by initial slow injection of a low dose of propofol by the same intravenous line. METHODS: Seventy-seven adult surgical patients were cannulated in a dorsal vein on each hand. In each cannula, a 0.5-ml priming dose of either propofol 10 mg/ml dissolved in an emulsion of medium- and long-chain triglycerides or aqueous sodium chloride 9.0 mg/ml was injected over 30 s, and followed 120 s later by a main dose of 2.0 ml of the same propofol formula over 6 s. After each injection, the patients were asked by a blind investigator to score the maximal pain intensity on a visual analogue scale (VAS). RESULTS: Although the decrease in maximal pain intensity did not reach statistical significance (P= 0.070), significantly fewer patients reported moderate or severe pain intensity (corresponding to 3.0 VAS units or more) after the main dose of propofol was preceded by a priming dose of propofol than by sodium chloride (P= 0.041). CONCLUSIONS: The incidence of moderate to severe local pain induced by intravenous propofol can be decreased by a readily applicable technique in which a low dose of propofol emulsion is slowly administered by the same intravenous route 2 min in advance.     

Effectiveness of a clinical guide for the treatment of postoperative pain in a major ambulatory surgery unit

A retrospective study to evaluate a clinical guide for the treatment of postoperative pain in our One Day Surgery Unit (ODSU) is presented. A total of 2783 patients, treated during 1 year, were studied. Postoperative pain was evaluated 24 h after surgery by phone-call using a visual analogue scale (VAS) and a verbal response scale (VRS). Results were analysed by groups of analgesia and pain scale values. Admissions due to insufficient analgesia were also evaluated. Mean values obtained in all analgesic groups in relation to the VAS were lower than 2.5. It was found that 86% of patients presented a value of VAS<3, while 84.6% had a VRS value 2. Only two patients were admitted for uncontrolled postoperative pain. The level of postoperative analgesia in our patients was satisfactory. Despite this continuous evaluation of the clinical guides for the treatment of postoperative pain, the use of new powerful analgesic drugs is necessary because the surgical complexity in ODSU is increasing and patients with associated diseases are increasingly accepted.     

Sustained intravascular exposure to propofol does not prolong pain at the site of injection

BACKGROUND: Pain at the site of intravenous injection of propofol is a common clinical finding. This double-blind, randomized cross-over study was designed to evaluate whether venous occlusion applied during injection of a low dose of propofol reduces the intensity of pain at the site of injection compared with no occlusion. METHODS: Bilateral 0.5-ml injections of an emulsion containing 10 mg/ml of propofol were given over 30 s in 75 adult surgical patients. Each patient was given one injection with and one without 60-s occlusion of the cannulated vein with a 10-min interval, and asked to score the maximal pain intensity on a visual analogue scale (VAS). RESULTS: The maximal pain intensity [median (25th percentile; 75th percentile), range] at the site of injection was 0.5 (0; 3.5), 0-8.0 VAS units with venous occlusion and 0.5 (0; 1.4), 0-6.0 VAS units without occlusion (P= 0.042). Pain was first reported within 20 s regardless of the study regimen and was not prolonged by local venous occlusion. CONCLUSION: Venous occlusion augments pain intensity at the site of propofol injection without prolonging pain, implying that propofol-induced pain is determined more by the blood concentration than by the duration of intravascular exposure. The low intensity of pain induced by low-dose propofol and the fading of pain despite sustained exposure suggest that initial low-dose administration of propofol should be evaluated for the attenuation of local pain induced by higher intravenous doses of propofol.     

Treatment for postoperative wound pain in gynecologic laparoscopic surgery: topical lidocaine patches

Abstract Background: This article reports our early experience with the use of lidocaine patches for pain control in the immediate postoperative period after laparoscopic gynecologic surgery. Subjects and Methods: A prospective, double-blind, placebo-controlled clinical trial was conducted on 40 patients undergoing a gynecologic laparoscopy who were randomized to receive either topical patches of 700?mg of lidocaine (n=20) or placebo patches (n=20). The patch was divided evenly into four smaller patches, which were applied at the four port sites and changed every 12 hours for 36 hours after surgery. Postoperative pain was evaluated using the visual analog scale (VAS) score and the Prince Henry and 5-point verbal rating pain scale (VRS), and the analgesic requirement was also evaluated at 1, 6, 12, 24, and 36 hours after surgery. Results: The VAS score for wound pain was lower in the lidocaine patch group at 1 and 6 hours after surgery than the control group (P=.005 and <.0005, respectively). The VAS scores for postoperative pain were lower in the lidocaine patch group at rest 1 hour after surgery (P=.045). The 5-point VRS score for postoperative pain was lower in the lidocaine patch group at 6 and 12 hours after surgery (P=.015 and .035, respectively) than in the control group. Conclusions: Topical lidocaine patches at the laparoscopic port sites reduced postoperative pain, particularly postoperative wound pain after gynecological laparoscopic procedures.     

Less local pain on intravenous infusion of a new propofol emulsion

Background: Local pain at the site of intravenous (iv) injection of propofol remains a considerable problem in clinical anaesthesiology, and particularly so in infants. The aim of the present study was to compare the influence of two different emulsions of propofol on local pain following iv administration. Methods: Eighty adult patients (ASA I–II) scheduled for ear‐nose‐throat or plastic surgery were randomly allocated into two study groups: A and B. A 1.0‐mm teflon cannula (BD, Helsingborg, Sweden) was inserted into a dorsal vein on each hand. Each patient was given two 3.0‐ml iv bolus injections of two different propofol emulsions of 10 mg ml^?1 over 2 s, one in each cannula, at 5‐min intervals. The first study drug administered was Diprivan^® (AstraZeneca, Södertälie, Sweden) in group A (n = 34) and Propofol‐Lipuro (Braun, Melsungen, Germany) in group B (n = 39). Each patient was then asked by a blinded investigator to score maximal pain intensity on a visual analogue scale (VAS). Results: The maximal intensity of propofol‐induced local pain was significantly (P < 0.0001) lower after Propofol‐Lipuro than after Diprivan^®– median 1 (25th percentile: 0; 75th percentile: 2) range 0–6 vs. 3 (0; 5) 0–9 VAS units. Conclusion: The considerably lower intensity of local pain found to be associated with iv administration of the new drug formula Propofol‐Lipuro indicates that emulsions of propofol based on medium‐ and long‐chain triglycerides have a clinical advantage over traditional ones for induction of anaesthesia.     

Propofol-induced injection pain: comparison of a modified propofol emulsion to standard propofol with premixed lidocaine

Propofol is well known for its association with pain on injection. The most frequently used method to reduce this pain is premixture with lidocaine. Recently, a modified lipid emulsion of propofol containing medium-chain triglycerides (MCT) with long-chain triglycerides (LCT), in contrast to the usual LCT formulation, has been advocated to alleviate pain. In a randomized, prospective, controlled, double-blind study on 222 surgical patients, we compared the effect of the two solutions on the incidence and intensity of injection pain. Patients were randomly allocated to receive either propofol MCT/LCT (group M; n = 109) or standard propofol LCT with the addition of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of propofol (group L; n = 113). Pain scores were assessed using a verbal analog scale (VAS) ranging from 0-10. Group L was found to have significantly less pain on the injection of propofol (mean VAS, 2.5 +/- 2.9) (mean +/- sd) than group M (mean VAS, 3.8 +/- 3.2; P = 0.002). Regarding postoperative recall of pain on injection, patients in group L indicated significantly less pain (mean VAS, 2.2 +/- 2.4) than patients in group M (mean VAS, 3.0 +/- 2.7; P = 0.02). Premixing of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of standard propofol LCT causes less pain on injection than propofol MCT/LCT and thus increases patient comfort.     

Pain on injection of propofol with or without infusion of carrier fluid

BACKGROUND: Propofol, a popular intravenous (iv) anaesthetic induction agent for brief cases or day surgery, is associated with smooth induction, pleasant sleep, rapid recovery and little postoperative nausea. A major disadvantage is pain at the site of injection. The aim of the present study was to examine the influence of simultaneous iv infusion of carrier fluid on propofol-induced local pain. METHODS: Thirty patients, scheduled for ear-nose-throat or plastic surgery under general anaesthesia, were randomly allocated into two groups. Each patient had two 2 ml iv bolus injections of propofol given at two minutes' interval. In group I (n=15) the first bolus injection was given with no iv carrier fluid and the second one given with a 10 ml iv carrier fluid infused over 10 s. Correspondingly, the patients in group II (n=15) had their first injection with and their second one without the iv carrier fluid. Following each injection of propofol the patients were asked by a blinded investigator to score their pain on a 10-point visual analogue scale, and to report the appearance, maximum and disappearance of pain. After the second assessment of pain, general anaesthesia was induced with more propofol. RESULTS: Pain intensity at the site of propofol injection was found not to be influenced by simultaneous iv infusion of carrier fluid. CONCLUSION: It seems, from the results obtained here, that simultaneous iv infusion of carrier fluid has no particular effect on local pain following iv administration of propofol.     

帕瑞昔布钠复合吗啡对瑞芬太尼致骨科手术患者术后痛觉过敏的影响

目的 探讨帕瑞昔布钠复合吗啡对瑞芬太尼致骨科手术患者术后痛觉过敏的影响.方法 择期拟行骨科手术患者60例,ASA分级Ⅰ或Ⅱ级,年龄20～62岁,体重45～100 kg,随机分为3组(n=20).静脉注射咪达唑仑、异丙酚、瑞芬太尼和罗库溴铵麻醉诱导,气管插管后行机械通气.气管插管完成后,M组静脉注射吗啡0.15 mg/kg;MP1组静脉注射帕瑞昔布钠20 mg和吗啡0.075 mg/kg;MP2组静脉注射帕瑞昔布钠40 mg和吗啡0.075 mg/kg.术中静脉输注异丙酚和瑞芬太尼,间断静脉注射维库溴铵维持麻醉.记录苏醒时间、意识恢复时间和拔管时间;记录拔管期间躁动和寒战的发生情况,以及意识恢复后5 min时的口述痛觉评分(VRS评分).分别于术后1 h(T1)、2 h(T2)、4 h(T3)、8 h(T4)、12 h(T5)和24 h(T6)时,采用VAS评分评价患者静态和动态的疼痛程度,同时记录MAP和HR.记录术后24 h内恶心呕吐的发生情况.分别于麻醉诱导前、术毕和术后24 h时,采集外周静脉血样2 ml,采用ELISA法测定血浆前列腺素E2(PGE2)和TNF-α的浓度.结果 三组苏醒时间、意识恢复时间、拔管时间、VRS评分、MAP、HR、躁动、寒战和恶心呕吐发生率比较差异无统计学意义(P＞0.05).与M组比较,MP1组T1～2时静态VAS评分升高,T1-6时动态VAS评分升高,MP2组T1-5时静态和动态VAS评分降低(P＜0.05);与MP1组比较,MP2组T1-6时静态VAS评分降低,T1-5时动态VAS评分降低(P＜0.05).与M组比较,MP1组各时点血浆PGE2和TNF-α的浓度差异无统计学意义(P＞0.05),MP2组术毕血浆PGE2和TNF-α的浓度降低(P＜0.05);与Mpi组比较,MP2组术毕时血浆PGE2和TNF-α的浓度降低(P＜0.05).结论 术前静脉注射帕瑞昔布钠40 mg复合吗啡0.075 mg/kg可减轻瑞芬太尼致骨科手术患者术后痛觉过敏,且效果优于单独应用吗啡.