体外冲击波碎石术自主呼吸时瑞芬太尼与舒芬太尼的比较：一项双盲随机研究

Remifentanil compared with sufentanil during extra-corporeal shock wave lithotripsy with spontaneous ventilation: a double-blind, randomized study.

作者信息

Beloeil H, Corsia G, Coriat P, Riou B

机构信息

Department of Anaesthesiology and Critical Care, Groupe hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, Paris, France.

出版信息

Br J Anaesth. 2002 Oct;89(4):567-70. doi: 10.1093/bja/aef202.

DOI:10.1093/bja/aef202

PMID:12393357

Abstract

BACKGROUND

The pharmacokinetic properties of remifentanil may allow a rapid analgesic action during painful procedures and short lasting postoperative respiratory depression.

METHODS

We carried out a randomized, blind, study in 60 patients to compare remifentanil (continuous i.v. infusion starting at 0.025 micro g kg(-1) min(-1)) and sufentanil (i.v. doses of 0.15 micro g kg(-1)) during extra-corporeal shock wave lithotripsy (ESWL). Pain was assessed using a numerical pain scale (0-100), and pain relief was defined as a score < or =30. Respiratory depression was defined as a ventilatory frequency less than10 breaths min(-1) on two occasions or a peripheral oxygen saturation < or =92%, or administration of naloxone.

RESULTS

The quality of analgesia was similar in both groups, during and after ESWL. During ESWL, there was no significant difference in respiratory depression in the remifentanil and sufentanil groups (53 vs 73%, NS). The percentage of satisfied patients (73 vs 83%, NS) and satisfied surgeons (97 vs 100%, NS) did not significantly differ between groups. After the procedure patients given remifentanil had less respiratory depression (20 vs 53%, P<0.05) and less nausea and vomiting (3 vs 20%, P<0.05).

CONCLUSION

A continuous i.v. infusion of remifentanil provided comparable analgesia and caused less respiratory depression and nausea and vomiting than i.v. boluses of sufentanil in patients undergoing extra-corporeal shock wave lithotripsy.

摘要

背景

瑞芬太尼的药代动力学特性使其在疼痛操作过程中可产生快速镇痛作用，且术后呼吸抑制持续时间短。

方法

我们对60例患者进行了一项随机、盲法研究，以比较体外冲击波碎石术（ESWL）期间瑞芬太尼（以0.025μg·kg⁻¹·min⁻¹开始持续静脉输注）和舒芬太尼（静脉注射剂量为0.15μg·kg⁻¹）的效果。使用数字疼痛评分量表（0 - 100）评估疼痛，疼痛缓解定义为评分≤30。呼吸抑制定义为两次呼吸频率低于10次/分钟或外周血氧饱和度≤92%，或使用纳洛酮。

结果

ESWL期间及之后，两组的镇痛质量相似。ESWL期间，瑞芬太尼组和舒芬太尼组的呼吸抑制无显著差异（53%对73%，无统计学意义）。两组之间满意患者的百分比（73%对83%，无统计学意义）和满意外科医生的百分比（97%对100%，无统计学意义）无显著差异。术后，接受瑞芬太尼的患者呼吸抑制较少（20%对53%，P<0.05），恶心和呕吐也较少（3%对20%，P<0.05）。