雷米芬太尼和芬太尼用于脊柱侧弯后路矫形手术的麻醉效果比较

中国临床药理学与治疗学 ›› 2008, Vol. 13 ›› Issue (12): 1426-1429.

雷米芬太尼和芬太尼用于脊柱侧弯后路矫形手术的麻醉效果比较

靳艳卿, 马正良, 顾小萍, 钟妤

南京大学医学院附属鼓楼医院麻醉科, 南京 210008, 江苏

收稿日期:2008-11-08 修回日期:2008-12-16 发布日期:2020-10-30
通讯作者: 马正良,男,教授,博士生导师,研究方向:急慢性疼痛的机理及其防治,围术期脑保护。Tel:025-83106666-10502
作者简介:靳艳卿,女,在读博士,主治医师,研究方向:急慢性疼痛的机理及其防治。Tel:13851803369 E-mail:jeanmd@163.com

Comparison on anesthetic effects of remifentanil and fentanyl for posterior scoliosis correction

JIN Yan-qing, MA Zheng-liang, GU Xiao-ping, ZHONG Yu

Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu, China

Received:2008-11-08 Revised:2008-12-16 Published:2020-10-30

摘要/Abstract

摘要： 目的比较雷米芬太尼和芬太尼用于脊柱侧弯后路矫形手术的麻醉效果及其对术后疼痛的影响。方法择期行脊柱侧弯后路矫形手术的患者40 例, ASA Ⅰ ~ Ⅱ级, 年龄11 ~ 18 岁。随机分为两组:雷米芬太尼组(R 组) 和芬太尼组(F 组)。以丙泊酚、维库溴铵和七氟醚维持麻醉。以R 组(0.2μg°kg^-1·min^-1) 和F 组(1μg°kg^-1°h^-1) 持续静脉输注维持术中镇痛。唤醒前半小时左右停用维库溴铵和镇痛药。唤醒时间为停用丙泊酚和七氟醚到患者双侧脚趾能动的时间。手术结束前R组停用雷米芬太尼后给予芬太尼2μg kg, 术后两组以芬太尼10μg°kg^-1·min^-1 持续静脉镇痛, 随访患者术后24 h 内的疼痛情况。结果 R 组术中唤醒时间(12.3 ±5.7) min 明显短于F 组(21.6 ±6.5) min (P <0.01)。两组患者术后镇痛满意,术后疼痛评分(VAS 评分) 两组间比较差异无统计学意义。结论在脊柱侧弯后路矫形手术中, R 组患者术中唤醒明显快于F 组。术中停用雷米芬太尼(0.2μg°kg^-1·min^-1) 后及时追加芬太尼, 术后未诱发明显的痛觉过敏。

关键词: 唤醒试验, 七氟醚, 雷米芬太尼, 脊柱手术

Abstract: AIM: To compare the effects of remifentanil and fentanyl for posterior scoliosis correction and the influences on postoperative pain.METHODS: Forty patients scheduled for posterior scoliosis correction (ASA Ⅰ-Ⅱ, aged 11-18 years) were randomly divided into group remifentanil (group R) and group fentanyl (group F).Anesthesia was maintained with propofol, vecuronium bromide and sevoflurane. Intravenous remifentanil (0.2μg°kg^-1°min^-1) and fentanyl (1μg°kg^-1°h^-1) were continuously administered for analgesia.Vecuronium bromide and analgesics were discontinued around 30 min before the wake-up test.The wake up time from propofol and sevoflurane discontinuation to movement of the patient's toe were recorded.In group R, once remifentanil infusion was stopped before surgery ended, the patients were injected with fentanyl 2μg kg.All of the patients received intravenous fentanyl (10μg°kg^-1°min^-1) for postoperative analgesia and were interviewed for pain degree during the first 24 h after surgery.RESULTS: The wake-up time were (12.3 ±5.7) min in group R and (21.6 ±6.5) min in group F(P <0.01).The analgesia efficacies in two groups were satisfactory.There was no significant difference in VAS (visual analog scale) score between the two groups during the first 24 h after surgery.CONCLUSION: Compared with group F, the wake-up time was shorted obviously in group R in posterior scoliosis correction.Remifentanil (0.2μg°kg^-1°min^-1) did not trigger postoperative hyperalgesia when fentanyl was applied after discontinuation of remifentanil during the surgery.

Key words: wake-up test, sevoflurane, remifentanil, spinal surgery

中图分类号:

R614.2

靳艳卿, 马正良, 顾小萍, 钟妤. 雷米芬太尼和芬太尼用于脊柱侧弯后路矫形手术的麻醉效果比较[J]. 中国临床药理学与治疗学, 2008, 13(12): 1426-1429.

JIN Yan-qing, MA Zheng-liang, GU Xiao-ping, ZHONG Yu. Comparison on anesthetic effects of remifentanil and fentanyl for posterior scoliosis correction[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2008, 13(12): 1426-1429.

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