帕瑞昔布联合地佐辛抑制瑞芬太尼全静脉麻醉术后痛觉超敏

目的 观察单独给予地佐辛或地佐辛联合帕瑞昔布对瑞芬太尼复合静脉全身麻醉术后痛觉超敏的影响.方法 拟全麻下行子宫切除术患者150例,ASA Ⅰ～Ⅱ级,随机分为Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组和Ⅴ组,每组各30例.手术结束前30 min,Ⅰ组静脉给予帕瑞昔布钠40 mg,Ⅱ组给予芬太尼1μg/kg,Ⅲ组和Ⅳ组分别给予地佐辛5 mg和10 mg,Ⅴ组给予地佐辛5 mg联合帕瑞昔布钠40 mg.观察比较苏醒期五组患者的躁动评分（RS）、镇静评分（Ramsay）和疼痛评分（VAS）、不良反应（嗜睡、恶心、呕吐等）.记录自停药至患者自主呼吸恢复时间、睁眼时间和拔管时间.结果 Ⅱ组、Ⅳ组和Ⅴ组患者躁动和疼痛发生率均低于Ⅰ组和Ⅲ组（P＜0.05）,Ⅱ组、Ⅳ组和Ⅴ组间差异无统计学意义（P＞0.05）.Ⅱ组和Ⅳ组不良反应发生率高于Ⅰ组、Ⅲ组和Ⅴ组（P＜0.05）.呼吸恢复时间、睁眼时间、拔管时间五组比较,Ⅱ组和Ⅳ组稍延长,但差异无统计学意义.结论 帕瑞昔布联合地佐辛能有效抑制瑞芬太尼复合全麻术后痛觉超敏,效果满意,药物相关不良反应少,安全可行.

Parecoxib combined with dezocine attenuates postoperative allodynia and hyperalgesia after remifentanil based intravenous anesthesia

Objective To investigate the effect of premedication of dezocine parecoxib combined with dezocine on postoperative allodynia and hyperalgesia after remifentanil based combined anesthesia. Methods 150 patients with hysteromyoma, scheduled for hysterectomy, ASA grade Ⅰ -Ⅱ, who would receive remifentanil based combined general anesthesia, were randomly divided into 5 groups. Parecoxib 40 mg was given to group I , Fentanyl 1μg/kg was given to group II , dezocine 5 mg and 10 mg were given to Ⅲ and Ⅳ groups respectively, and dezocine 5 mg combined with parecoxib 40 mg were given to group V at 30 min the end of the operations intravenously. Observe and compare the emergence of five groups of patients the occurrence of agitation, pain score and side effects （ nausea, vomiting, etc. ）, and spontaneous breath recovery time, open time and extubation time were recorded as welL Results In Ⅱ ,Ⅳ and Ⅴ groups the incidence of agitation and pain was lower than in Ⅰ and Ⅲ groups（P 〈 0. 05 ）. In Ⅱ ,Ⅳ andⅤ groups there was no significant difference（ P 〉0. 05 ）. In Ⅱ andⅣ groups adverse reaction rate was more than in Ⅰ , Ⅲ and Ⅴ groups （P 〈 0.05 ）. No significant statistic differences had been showed in spontaneous breath recovery time, open time and extubation time among five groups. Conclusions Parecoxib combined with dezocine preemptive analgesia in preventing of early postoperative pain has a good effect, and can reduce the incidence of adverse reactions.