多模式超前镇痛在妇科腹腔镜手术中的应用

目的：探讨多模式超前镇痛在妇科腹腔镜手术的术后镇痛作用。方法80例择期行妇科腹腔镜手术患者，ASAⅠ～Ⅱ级，年龄25～64岁，随机双盲分为对照组（C 组）、地佐辛组（D 组）、帕瑞昔布钠组（P 组）、多模式镇痛组（PM组），每组20例，分别于麻醉诱导前5 min 给予生理盐水、地佐辛10 mg、帕瑞昔布钠40 mg 及地塞米松10 mg、地佐辛10 mg，复合帕瑞昔布钠40 mg 静脉注射。各组麻醉维持采用异丙酚和瑞芬太尼静脉麻醉，统计各组术中瑞芬太尼用量（RFC），记录术后患者拔除喉罩后0、1、2、4、8、12、24 h（T 1－7）的疼痛视觉模拟评分（VAS 评分），记录术后各组补救镇痛的时间和剂量，观察术后不良反应。结果C 组术中瑞芬太尼用量多于其他各组。拔除喉罩后0、1、2、4、8、12 h 的 VAS 评分，D 组、P 组均低于 C 组（P ＜0．05），PM组低于 D 组、P 组、C 组（P ＜0．05）。各组中患者于拔出喉罩后1、2、4 h 需要补救镇痛的例数，C 组多于 D 组、P 组（P ＜0．05），而 PM组不需要补救镇痛（P ＜0．05）。其他不良反应无明显差异。结论多模式超前镇痛在妇科腹腔镜手术有更好的镇痛效果，明显优于单一用药。

Effect of preemptive multimodal analgesia (PMMA) in patients undergoing gynaecological laparoscopic surgery

Objective To determine the effect of preemptive multimodal analgesia in the patients undergoing gynaecological laparoscop-ic surgery.Methods Eighty patients aged 25 to 64 years old,ASAⅠ ~Ⅱ,undergoing selective gynaecological laparoscopic surgery were prospectively,randomly and double-blinded assigned into four groups (n =20),control group (C group),dezocine group (D group),parecoxib group (P group)and preemptive multimodal analgesia group (PMgroup).C group was given normal saline intrave-nously,D group dezocine 10mg,P group parecoxib 40 mg and PMgroup ezocine 10 mg plus parecoxib 40 mg plus dexamethasone10 mg 5 minutes before induction.The anesthesia was maintained with intravenous propofol and emifentanil.The average of remifentanil con-sumption was counted.The VAS scales were recorded 0,1,2,4,8,12,24 h(T 1 -7)after extubation.The induction and postoperative complications were recorded.Results The average remifentanil consumption(RFC)of C group was higher than the other three groups. VAS scales of D group and P group were lower than C group’s(P <0.05)and the VAS scales of PMgroup were lower than D group’ s,P group’s and C group’s at the time of 0、1、2、4、8、12 h after extubation(P <0.05).More patients in C group needed rescue anes-thetics 1,2 or 4 h after extubation than D,T group’s,and patients in PMgroup didn’t need any rescue anesthetics (P <0.05).There was no difference in other complications between the four groups.Conclusions The preemptive multimodal analgesia was more effec-tive than preemptive analgesia with single analgesic in laparoscopic cholecystectomy.