上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (4): 509-513.doi: 10.3969/j.issn.1674-8115.2021.04.015

• 论著·临床研究 • 上一篇    下一篇

术中瑞芬太尼持续泵注对胃肠术后镇痛的影响

李璐宏(), 罗艳()   

  1. 上海交通大学医学院附属瑞金医院麻醉科，上海 200025
  • 收稿日期:2020-05-20 出版日期:2021-04-28 发布日期:2021-05-14
  • 通讯作者: 罗艳 E-mail:llh6177@sjtu.edu.cn;18917762576@163.com
  • 作者简介:李璐宏（1992—），女，硕士生；电子信箱：llh6177@sjtu.edu.cn。

Impact of intraoperative continuous pumping of remifentanil on postoperative analgesia after gastrointestinal surgery

Lu-hong LI(), Yan LUO()   

  1. Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2020-05-20 Online:2021-04-28 Published:2021-05-14
  • Contact: Yan LUO E-mail:llh6177@sjtu.edu.cn;18917762576@163.com

RichHTML

3

PDF (PC)

550

摘要：

目的·探讨胃肠术中瑞芬太尼持续低剂量［0.05~0.15 μg/（kg·min）］泵注对术后镇痛效果的影响。方法·回顾性分析2019年4月—12月于上海交通大学医学院附属瑞金医院行择期胃肠术并使用患者自控静脉镇痛（patient-controlled intravenous analgesia，PCIA）的患者695例，根据术中是否持续泵注瑞芬太尼0.05~0.15 μg/（kg·min），分为瑞芬太尼组（n=360）和对照组（n=335），应用倾向性评分匹配分析患者术后镇痛补救以及患者自控镇痛（patient-controlled analgesia，PCA）按压情况。结果·通过倾向性评分1∶1匹配，286对患者配对成功。瑞芬太尼组中接受镇痛补救人数占比明显低于对照组（32.5% vs 40.9%，P=0.037），且瑞芬太尼组术后出现PCIA镇痛效果不佳并需镇痛补救的风险降低（RR=0.696，95%CI 0.495~0.980）。瑞芬太尼组和对照组患者PCA总按压次数的中位数（四分位数间距）分别为5（1，12）和5（1，13），差异无统计学意义（P=0.568），但瑞芬太尼组中PCA按压次数>13次的患者占比少于对照组（21.3% vs 24.5%）。结论·择期胃肠手术中瑞芬太尼0.05~0.15 μg/（kg·min）持续泵注有助于改善术后镇痛需求，患者术后出现PCIA镇痛效果不佳且需镇痛补救的风险较低。

关键词: 瑞芬太尼, 镇痛效果, 患者自控静脉镇痛, 胃肠手术

Abstract:

Objective· To explore the effect of intraoperative continuous remifentanil infusion at the 0.05?0.15 μg/(kg·min) dosage on postoperative analgesia after gastrointestinal surgery.

Methods· The patients received patient-controlled intravenous analgesia (PCIA) after elective gastrointestinal surgery from April to December 2019 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were included in this retrospective analysis. They were divided into remifentanil group (n=360) and control group (n=335) according to whether the patients were treated with intraoperative continuous pumping of remifentanil at the 0.05?0.15 μg/(kg·min) dosage. Propensity score matching (PSM) was used to compare the difference of postoperative analgesic remedy and the pressing of patient-controlled analgesia (PCA) between the two groups.

Results· By using a 1∶1 PSM analysis, 286 couples of patients were matched successfully. In the remifentanil group, the proportion of patients receiving postoperative analgesic remedies was significantly less than that in the control group (32.5% vs 40.9%, P=0.037). Compared with the control group, the remifentanil group had a lower risk of poor analgesic effect and necessity of postoperative analgesic remedies (RR=0.696, 95%CI 0.495?0.980). There was no significant difference in the total PCA pressing times between the remifentanil group and control group [5 (1, 12) vs 5 (1, 13), P=0.568], but in the remifentanil group, the proportion of patients with PCA pressing times > 13 was less than that of the control group (21.3% vs 24.5%).

Conclusion· Continuous pumping of remifentanil at the 0.05?0.15 μg/(kg·min) dosage in elective gastrointestinal surgery is helpful to decrease postoperative analgesic demand. The patients receiving intraoperative remifentanil infusion at a low dosage has a lower risk in requiring postoperative analgesic remedies, compared with patients who do not receive intraoperative remifentanil infusion.

Key words: remifentanil, analgesic effect, patient-controlled intravenous analgesia (PCIA), gastrointestinal surgery

中图分类号: