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Objective 1, observe laparoscopic cholecystectomy (LC) intraoperative remifentanil continuous infusion of different doses, whether caused by surgery and hyperalgesia hyperalgesia severity of the dose is about. 2, the determination of different doses of tramadol inhibition surgery remifentanil-induced hyperalgesia median effective dose (ED50) and 95% confidence intervals (CI). Method Test is divided into two parts: the first part of the elective LC 60 patients were randomly divided into A, B, C three groups of 20 cases. A group, B group, anesthesia was induced with remifentanil 1.5μg/kg, cis-atracurium 0.2mg/kg and propofol 2mg/kg, C group instead of remifentanil with fentanyl 3μg/kg. Intubation after A, B groups respectively 0.3μg / (kg · min) .0.2 μg / (kg · min) infusion rate of remifentanil, C group fentanyl, three different groups were simultaneously complex continuous infusion of propofol, according to need surgery, intermittent intravenous cis-Atracurium maintain muscle relaxants. Record of surgery awake extubation 15min, 30min, 1h, 90min, 2h, 4h, 8h VAS scores and compare them. According to the patient requires intramuscular pethidine analgesia. Part II: elective LC were randomly divided into AT group [intraoperative continuous infusion of remifentanil 0.3μg / (kg · min)] and BT group [intraoperative continuous infusion of remifentanil 0.2μg / (kg · min)]. Both groups were given at 5min before surgery tramadol, tramadol dosage determined by sequential method, the initial dose of 0.8mg/kg, adjacent dose ratio was 1.25, 15min after surgery awake extubation for VAS score, VAS gt; 4 classified as positive, considering the inhibition of hyperalgesia tramadol invalid, then the next one patient tramadol dose intends to increase one level; if the VAS score lt; 4 is negative, the next one patient dose to be reduced by one grade, Selected samples from the occurrence of a case before negative reactions began doing enough 30 cases in each group. Dixon-Massey sequential method using statistical formulas tramadol median effective dose (ED50) and 95% confidence intervals (CI). 1, three groups of patients intraoperative hemodynamic stability, no significant difference between the two groups; surgery the incidence of adverse reactions, no significant difference. Extubation time leader in group A, C and B group, the difference was statistically significant (P lt; 0.05). After surgery awake extubation within 2h, A group and B group, VAS score was significantly higher than that in group C (P lt; 0.05); A group VAS score was higher than in group B (P lt; 0.05), 2h after each group VAS score was no significant difference (P gt; 0.05). A, B group required postoperative analgesia was significantly more than the number of patients in group C, P lt; 0.05, and the time to first request for analgesia significantly earlier than the C group, P lt; 0.05. 2, A. tramadol inhibition of remifentanil hyperalgesia ED50 of 1.78 mg / kg, 95% CI 1.65mg/kg ~ 1.93mg/kg, BT tramadol inhibits its hyperalgesia ED50 of 1.31 mg / kg, 95% can be confidence interval 1.23mg/kg ~ 1.39mg/kg. Conclusions 1, LC intraoperative continuous infusion 0.2μg / (kg · min) or 0.3μg / (kg · min) of remifentanil anesthesia stable, rapid awakening But after stopping cause hyperalgesia, the greater the dose of remifentanil infusion, hyperalgesia surgery more severe postoperative hyperalgesia to within 2h most significant. 2, preoperative intravenous tramadol can be effectively suppressed after discontinuation of remifentanil-induced hyperalgesia. Intraoperative remifentanil dose greater need tramadol more. Tramadol remifentanil to 0.3μg / (kg · min) infusion rate induced hyperalgesia ED50 of 1.78mg/kg, inhibition of remifentanil to 0.2μg / (kg · min) infusion rate induced hyperalgesia ED50 of 1.31mg/kg.
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