预先使用氢吗啡酮对瑞芬太尼诱发患者术后痛觉过敏的效果

【摘要】 目的 观察预先使用氢吗啡酮对持续静脉输注瑞芬太尼后诱发痛觉过敏的影响。方法〓60名脊柱手术患者,32~65岁,ASA分级Ⅰ~Ⅱ级,被分为三组:对照组(C组),芬太尼组(F组),氢吗啡酮组(M组)。三组患者术中均持续静脉输注瑞芬太尼0.2 μg·kg-1·min-1、复合吸入地氟醚、间断静脉注射罗库溴铵维持麻醉。F组、M组分别于手术结束前10 min静脉注射芬太尼2 μg/kg、氢吗啡酮0.04 mg/kg,C组给予等容量的生理盐水。观察三组术后患者的躁动、疼痛评分、血糖的变化。结果〓与C组比较,F、M组患者拔管时躁动评分、拔管后各时间点疼痛评分、血糖水平显著性降低(P<0.05);与F组比较,M组术后各时间点疼痛评分、血糖水平显著性降低(P<0.05)。结论〓预先使用氢吗啡酮可以减轻瑞芬太尼诱发的痛觉过敏,其效果优于等效镇痛剂量的芬太尼。

Effect of pretreatment with hydromorphone on the development of remifentanil -induced hyperalgesia

Objective To investigate the effect of pretreatment with hydromorphone on the development of remifentanil-induced hyperalgesia. Methods Sixty patients with ASA I or II were assigned to 3 groups for undergoing spinal operation. All the patients received desflurane inhalation anesthesia and continuous remifentanil infusion during operation. Remifentanil was given by continuous infusion at the rate of 0.2 μg·kg-1·min-1 in all groups. In control group (group C), 0.9% normal saline was administered intravenously 30 min before the end of operation. Fentanyl at a dose of 2 μg/kg was administered intravenously 30 min before the end of operation in group fentanyl (group F). Hydromorphone at a dose of 0.04 mg/kg was administered intravenously 30 min before the end of operation in group hydromorphone (group M). Pain and agitation score and the change of blood sugar were recorded after operation. Results Compared with Group C, agitation score at the time of extubation, pain score after extubation and the level of blood sugar were significantly decreased in Group F or M (P<0.05). Compared with Group F, pain score after extubation and the level of blood sugar were significantly decreased in Group M (P<0.05). Conclusion Pretreatment with hydromorphone can alleviate remifentanil -induced hyperalgesia, and the analgesic effect is better than that of equivalent dose of fentanyl.