三种镇痛药物预防瑞芬太尼麻醉后痛觉过敏的效果比较

目的观察芬太尼、曲马朵、地佐辛对瑞芬太尼麻醉后痛觉过敏的影响及不良反应。方法择期腹腔镜胆囊切除术患者80例，随机分为4组，均采用静脉与吸入复合麻醉，手术结束前15 min F组静脉注射芬太尼1μg／kg；T组静脉注射瞌马朵2mg／kg；D组静脉注射地佐辛0．1mg／kg；N组静脉注射0．9％生理盐水2 ml。记录手术时间、自主呼吸恢复时间、苏醒时间、拔管时间；并于苏醒拔管后即刻（T1）、苏醒后1h（T2）、苏醒后2h（T3）记录视觉模拟评分（VAS）、布氏舒适评分（BCS），记录术后躁动、恶心呕吐、呼吸抑制等不良反应的发生情况。结果D组、N组患者自主呼吸恢复时间、苏醒时间、拔管时间均短于F组和T组（P〈0．05），F组与T组比较无统计学差异（P〉0．05），D组与N组比较无统计学差异（P〉0．05）。N组与F组、T组、D组患者在术后T1、T2、T3时点VAS评分、BCS评分比较均有统计学差异（P〈0．05）。与F组和T组比较，D组和N组恶心呕吐发生率明显降低（P〈0．05），F组的呼吸抑制发生率高于其余3组（P〈0．05）。结论芬太尼、曲马朵、地佐辛均可减轻瑞芬太尼麻醉后的痛觉过敏，其中地佐辛的副作用较少。

Comparison of the effects of three different analgesics on preventing hyperaigesia after remifentanil an- esthesia

Objective To observe the effects of fentanyl,tramadol,dezocine on preventing hy- peralgesia after remifentanil anesthesia and the adverse effects. Methods Eighty patients undergoing laparoscopic eholecysteetomy were randomly divided into four groups. Patients in all groups were re- ceived combined intravenous inhalational anesthesia. Patients in group F were intravenously injected fentanyl 1 μg/kg, and group T, D, N were injected tramadol 2 mg/kg, dezocine 0.1 mg/kg, 0.9% saline solution 2 ml respectively at 15 rain before the end of operation. The operation time, spontane- ous breathing recovery time, wake up time, extubation time were recorded. VAS and BCS at differ- ent times after operation and the adverse reactions after endotracheal tube extubation were also recor- ded. Results Spontaneous breathing recovery time, waking up time, extubation time were signifi- cantly shorter in group D and N than those in group F and T. There was no significant difference be- tween group F and T （P〉0.05）. No significant differences were found between group D and N （P〉0.05）. VAS and BCS were significantly different between group N and group F, T, D （P〈0.05）. Compared with group F and T, the incidences of nausea and vomiting were significantly lower in group D and N （P〈0.05）, the incidence of respiratory inhibition in group F was significantly higher than that in the other three groups （P〈0.05）. Conclusion All of fentanyl, tramadol, dezo- cine can reduce the hyperalgesia after remifentanil anesthesia, but dezoeine with fewer side effects.