辅助硬膜外麻醉的瑞芬太尼-丙泊粉全麻术后阿片药物急性耐受的观念

目的:观察辅助硬膜外麻醉的瑞芬太尼丙泊粉全麻术后阿片药物急性耐受的情况。方法:人工股骨头置换手术病人20例,随机分2组,每组0例。术前用一次性自动采血针在左手无名指腹侧采血,测随机血糖1量,无异常后分次注入0.5%罗派卡因15ml,10分钟后行全麻诱导。2组全麻诱导都用依托咪酯0.3mg/kg、芬太尼0.2mg/kg,维库溴胺0.1mg/kg。全麻维持A、B组分别持续泵入瑞芬太尼0.5～1μg/kg/h、0.5μg/kg/h,2组均泵入丙泊酚6～10mg/kg/h。手术结束前5分钟停用维持药。手术结束后拔出气管导管。再用一次自动采血针在左手无名指腹侧采血,记录疼痛评分。A组立即给与芬太尼0.05mg。比较两次疼痛评分、瑞芬太尼、丙泊酚的用量。结果:2组病人术前疼痛评分的比较没有统计学差异(P0.05)。术后疼痛评分B组明显低于A组(P0.05)。与术前比较,A组明显升高(P0.05);B组变化不明显(P0.05),术中A组病人瑞芬太尼用量明显高于B组,(P0.05);2组丙泊粉用量没有统计学差异(P0.05)。结论:辅助硬膜外麻醉的瑞芬太尼-丙迫酚全麻时,硬膜外麻醉对外周有害刺激的有效阻断,不引起中枢神经的NMDA受体的兴奋,因而不产生阿片类药物急性耐受作用。

Observation of Actue Opiod Tolerance after Remifentanil -Propfol Anesthesia Combined epidural anesthesia

Objective:To observe the acute opiod tolerance after remifentanil proprol anesthesia combined epidural anesthesia.Methods:Twenty patients undergoing patients in each group.When properative little blood was collected with a disposable automatic blood collection needle in the left-hand ring finger,a random blood glucose level was measured.The patients's pain score were recorded by visual analogue scales(VAS).The patients in B group were given epidural puncture firstly,2% lidocain 3-5ml was used as epidural test volume.If no abnormalities,then 0.5% Ropivacaine 15ml was given,and general anesthesia induction was started 10 minutes after.Etomidate 0.3mg/kg,fentynal 0.2mg/kg and vicuranium 0.1mg/kg were used in two groups.The intravenously pumping dose of remifentanil in A,B group was 0.5-1μg/kg/h,0.5μg/kg/h respectively during operation.The dose of proprol was 6~10mg/kg/h equally.Remifentanil and propofol were stopped to intravenously pumping 5 minutes before the end of the operation.After pulling out the tracheal tube,little blood sample was collected like with the previous and the pain score were recorded.Fentyna 10.05mg was given to the patients in A group at once.Two pain score,the dosage of remifentanil and propfol were compared.Results:There were no significant differences in the pain score preoperatively between the two groups(P>0.05);the postoperative pain score of B group was significantly lower than that of A group(P<0.05).Compared the preoperative pain score,the date postoperative pain score of A group was increased significantly(P>0.05).The dosage of remifentanil during operation of A group was higher than that of B group(P<0.05).There were no significant differences in the dosage of propfol(P>0.05).Conclusion:When remifentanil-propfol anesthesia combined with epidural anesthesia,the peripheral and harmful stimulation was effectively blocked by epidural anesthesia,and the NMDA acceptor in central nervous system did was not excited.So there was no acute opiod tolerance after remifentanil-propfol anesthesia combined epidural anesthesia.