摘要
目的探讨芬太尼抑制瑞芬太尼静脉复合麻醉苏醒期急性疼痛的药效学。方法选择拟在全麻下行胃大部切除术男性患者28例,年龄26～58岁,ASAⅠ或Ⅱ级。麻醉诱导:咪达唑仑0.05mg/kg、丙泊酚2mg/kg、芬太尼3μg/kg、阿曲库铵0.8mg/kg。5min内完成气管插管行机械通气。于手术切皮前采用改良序贯法再次静脉注射芬太尼,除瑞芬太尼外,术中不再追加任何镇痛药物。手术结束前30min停用阿曲库铵,手术结束时停用瑞芬太尼和丙泊酚。记录手术时间、术后拔管时间及恶心呕吐等不良反应。拔管后30min测定患者全麻术后疼痛Prince-Henry评分,以Prince-Henry评分≥3分为发生术后急性疼痛。计算芬太尼ED50及其95%可信区间(CI)。结果芬太尼抑制瑞芬太尼静脉复合麻醉苏醒期急性疼痛的ED50及其95%CI分别为5.39μg/kg和5.21～5.58μg/kg。术后1例患者在拔管后40min发生呕吐。手术时间(93.8±10.2)min,术后拔管时间(14.2±3.5)min。结论芬太尼诱导剂量抑制瑞芬太尼静脉麻醉苏醒期急性疼痛的ED50及其95%CI分别为5.39μg/kg和5.21～5.58μg/kg。
Objective To determine the effect of fentanyl on emergence pain after intravenous remifentanil anesthesia. Methods Twenty-eight ASA I or II male patients, aged 26-58 years undergoing subtotal gastrectomy under general anesthesia were studied. Anesthesia was induced with midazolam 0. 05 mg/kg, propofol 2 mg/kg, fentanyl 3 μg/kg and atracurium 0. 8 mg/kg. The patients were mechanical ventilated after tracheal intubation for 5 w.in. Then fentanyl was injected again before incision by using modified Dixon＇s up-and-down method. The time of total operation, extubation after operation and side effects such as nausea and vomiting were recorded. The atracurium infusion was terminated 30 min before the end of surgery. Remifentanil and propofol were terminated at the end of surgery. The score of Prince-Henry scores≥3 was defined as postoperative acute pain. ED50 and 95% confidence interval （CI） of fentanyl on postoperative acute pain were calculated. Results ED50 was 5.39μg/kg. 95% CI was 5. 21-5.58/2g/kg. One patient vomited 40 min after extubation. The average operation time was （93.8 ±10. 2） rain and the time of extubation was （14. 2± 3. 5） min. Condusion The ED50 and 95% CI of fentanyl for inhibition of acute pain after intravenous remifentanil anesthesia were 5. 39μg/kg and 5.21-5. 58μg/kg respectively.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第6期532-534,共3页
Journal of Clinical Anesthesiology
关键词
芬太尼
瑞芬太尼
急性疼痛
药效学
Fentanyl
Remifentanyl
Acute pain
Pharmacodynamic
