韩　斌　徐铭军首都医科大学附属北京妇产医院麻醉科，北京100006

不同镇痛药物预防患者全麻术后苏醒期躁动和寒颤的临床研究

韩斌徐铭军
首都医科大学附属北京妇产医院麻醉科，北京100006

目的比较不同镇痛药物预防妇科腹腔镜手术全麻苏醒期躁动和寒颤的效果。方法选取2015年12月～2016年3月在北京妇产医院全麻下行择期腹腔镜全子宫切除手术的患者136例，ASAⅠ～Ⅱ级。术前应用随机数字表法，将入选病例随机分为舒芬太尼组（SF组，45例），帕瑞昔布组（P组，46例），曲马多组（T组，45例）。所有患者均采用全凭静脉麻醉，手术结束前10 min，SF组静脉推注舒芬太尼0.2 μg/kg，P组静脉推注帕瑞昔布40 mg，T组静脉推注曲马多100 mg。记录患者术毕（T1）、拔除气管导管时（T2）、拔管后30 min（T3），拔管后1 h（T4）、拔管后2 h（T5）的生命体征；记录T3、T4、T5视觉模拟评分（VAS）疼痛评分；记录术毕至拔管时间、拔除气管导管后1 h评估苏醒期的镇静评分、寒颤分级和躁动分级；记录患者恶心、呕吐等不良反应情况。结果P组、T组拔管时间与SF组比较，差异有高度统计学意义（P＜0.01）；P组、T组T1时间点平均动脉压与SF组比较，差异有统计学意义（P＜0.05）；P组、T组T3时间点VAS评分与SF组比较，差异有高度统计学意义（P＜0.01）；SF组、P组呕吐例数与T组比较，差异有统计学意义（P＜0.05）。结论帕瑞昔布是预防苏醒期躁动安全有效的药物，对预防寒颤也有一定的作用。

舒芬太尼；帕瑞昔布；曲马多；躁动；寒颤

［Abstract］Objective To compare the effect of different analgesics on postoperative agitation and shivering of patients after general anesthesia.Methods The study included 136 female patients with ASAⅠ-Ⅱreceived laparoscopic hysterectomy from December 2015 to March 2016 in Beijing Obstetrics and Gynecology Hospital，and they were randomly divided into Sufentanil group（SF group，45 cases），Parecoxib group（P group，46 cases），tramadol group（T group，45 cases）according to the Random number table，.All patients were treated with total intravenous anesthesia，anesthesia induction and maintenance by conventional methods，10 minutes before the end of surgery，SF group was given Sufentanil 0.2 μg/kg，P group was given Parecoxib 40 mg，T group was given tramadol 100 mg.The vital signs at the end of surgery（T1），extubation time（T2），30 minutes after extubation（T3），one hour after extubation（T4），2 hours after extubation（T5），VAS scores at T3，T4，T5were recorded；the time from the end of surgery to extubation were recorded；the occurrence of agitation and shivering was observed during waking up period in PACU.Ramsay sedation scores，Riker-SAS agitation scores，Wrench shivering scores were recorded after extubation 60 minutes；Nausea，vomiting and other adverse reactions were recorded.Results The extubation time of P group and T group had statistically significant difference with SF group（P＜0.01）；the MAP of the P group and T group at T1had statistically significant difference with SF group（P＜0.05）；VAS of P group and T group at T3had statistically significant difference with SF group（P＜0.05）；vomiting case of the P group and SF group had statistically significant difference with SF group（P＜0.05）.Conclusion Parecoxib is a safe and effective drugs for postoperative agitation and shivering.

［Kew words］Sufentanil；Parecoxib；Tramadol；Agitation；Shivering

瑞芬太尼是超短效阿片类镇痛药，常与丙泊酚复合应用于全凭静脉麻醉。由于瑞芬太尼的半衰期短，患者术后疼痛迅速恢复，可出现各种全麻苏醒期并发症。……