帕瑞昔布钠抑制瑞芬太尼术后痛觉过敏的量效关系

目的探讨帕瑞昔布钠抑制瑞芬太尼致患者术后痛觉过敏的量效关系。方法选择我院2010年1～6月期间,择期全麻下妇科腹腔镜手术患者40例,年龄19～45岁,体重45～70 kg,ASA I～II级。静脉注射芬太尼、丙泊酚和阿曲库铵麻醉诱导后,气管插管行全凭静脉全麻。术中静脉输注0.12μg.kg-1.min-1瑞芬太尼和75～200 mg.kg-1.min-1丙泊酚,间断静脉注射阿曲库铵维持麻醉。麻醉诱导后,采用序贯法静脉注射帕瑞昔布钠,初始剂量为0.6 mg/kg,相邻梯度为0.2 mg/kg,采用概率单位法计算患者术后痛觉过敏抑制时（气管拔管后10 min时VAS评分〈4分）帕瑞昔布钠的半数有效剂量（ED50）、95%有效剂量（ED95）及其95%可信区间。结果帕瑞昔布钠抑制瑞芬太尼致患者术后痛觉过敏的ED50（95%可信区间）为0.63 mg/kg（0.52mg/kg～0.75 mg/kg）,ED95（95%可信区间）为1.10 mg/kg（0.86 mg/kg～2.81 mg/kg）。结论帕瑞昔布钠抑制瑞芬太尼致患者术后痛觉过敏的ED50和ED95分别为0.63 mg/kg和1.10 mg/kg。

Dose-response Relationship of Parecoxib for Inhibiting Postoperative Hyperalgesia after Remifentanil-based Anesthesia

Objective To investigate dose-response relationship of parecoxib for inhibiting postoperative hyperalgesia after remifentanil-based anesthesia in patients undergoing gynecological laparoscopy.Methods Forty patients aged 19 ~ 45 years with ASA I or II,weighing 45 ~ 70 kg and undergoing gynecological laparoscopy under remifentanil-based general anesthesia were studied.Anesthesia used propofol 2 mg/kg,fentanyl 4 μg/kg and atracurium 0.6 mg/kg.Patients were given infusion of remifentail（0.12 μg·kg-1·min-1） and propofol（75 ~ 200 mg·kg-1·min-1） during the operation.Atracurium was given intermittently.The patients were mechanically ventilated after tracheal intubation.Parecoxib was given before skin incision for inhibiting remifentanil-induced postoperative hyperalgesia.Pain was assessed using VAS at 10 min after tracheal extubation.VAS score 4 was defined as effective.The optimal dose was determined by Dixon＇s up-and-down method.If the VAS score was 4,the next patient received a lower dose of parecoxib.If ineffective,a high dose was given in the next patient.The up-and-down sequences were analyzed by using probit method to determine the ED50,ED95 and 95% confidence interval（CI）.Results The ED50 and ED95 of parecoxib for inhibiting postoperative hyperalgesia after remifentanil-based anesthesia in patients following gynecological laparoscopy were 0.63 mg/kg（95% CI： 0.52 mg/kg ~ 0.75 mg/kg） and 1.10 mg/kg（95% CI： 0.86 mg/kg ~ 2.81mg/kg）.Conclusion The ED50 and ED95 of parecoxib for inhibiting postoperative hyperalgesia after remifentanil-based anesthesia in patients following gynecological laparoscopy are 0.63 mg/kg and 1.10 mg/kg respectively.