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摘要：
摘 要 目的 评价术中瑞芬太尼不同用量对上腹部手术后患者静脉自控镇痛效果的影响。方法 选取上腹部手术患者，采用随机数字表法随机分为两组，每组30例，分别为高剂量瑞芳太尼0.4μg• kg-1 •min-1（H组）和低剂量瑞芳太尼0.2μg• kg-1 •min-1（L组），两组均以瑞芬太尼、丙泊酚、阿曲库铵行静脉麻醉，术后采用舒芬太尼行静脉自控镇痛 (Patient-controlled intravenous analgesia PCIA)，分别记录术后2h、4h、12h、24h、48h两组患者疼痛视觉模拟评分(Visual Anaglogue Scale， VAS)， 镇静评分，术后48h舒芬太尼消耗量， PCIA总按压次数及不良反应的发生情况。结果术后2h、4h、12h、24h VAS评分（24±6,29±6, 25±6,21±7）与H组(42±7, 55±6 , 33±6 , 30±6 )比较显著下降(p< 0.05 )，镇静评分L组（2.7±0.3，2.3±0.4，2.1±0.3，2.0±0.1），与H组（1.7±0.2, 1.5±0.3, 1.2±0.2, 1.5±0.3）比较显著升高 (p< 0.05 )，术后48hL组舒芬太尼追加量及PCIA总按压次数分别为（155±9.2）μg和（5.6±0.9），与H组（176±13.0μg, 9.9±0.6）分别下降12%和43%(p< 0.05 )，不良反应发生率两组间比较差异无统计学意义（p>0.05）。结论 低剂量瑞芬太尼组与高剂量瑞芬太尼组比较有效改善术后镇痛效果，且无明显不良反应。
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Abstract: 【Abstract】Objective To assess the effects of intraoperative different doses of remifentanil to postoperative analgesic in patients underwen upper abdomen surgery . Methods Sixty patients underwent upper abdomen abdominal surgery were randomly divided in to two groups ( n = 30 each) ：They were by intraoperatived high dose remifentanil 0.4μg•kg-1•min-1 (group H) or low dose 0.2μg• kg-1•min-1 (group L) respectively. Anesthesia throughout surgery was maintained with i.v.propofol, remifentanil, musclerelaxant. Postoperative analgesia was provided by patient-controlled intravenous analgesia (PCIA)with sulfentanyl. the Visual Anaglogue Scale (VAS) and sedation score were measured at 2h, 4h, 12h, 24h, 48h postoperatively. sulfentany consumption was recorded and PCIA effect was observed in postoperative 48h. Resalt VAS in group L（24±6, 29±6, 25±6, 21±7） were significantly lower than in the group H(42±7, 55±6 , 33±6 , 30±6 )，while the sedation score（2.7±0.3, 2.3±0.4, 2.5±0.3, 2.0±0.1）were higher than in the group H（1.7±0.2, 1.5±0.3, 1.2±0.2, 1.5±0.3） at 2h, 4h, 12h, 24h postoperatively(p< 0.05 ); the postoperative total consumption of sulfentany（155±9.2） and the number of PCIA press times (5.6±0.9) in group L were decreased by 12% and 43% respectively compared with group H（176±13.0μg, 9.9±0.6）(p< 0.05 ); there was no significant different on side effects in two groups（p>0.05）. Conclusion：Compared with group H ( 0.4μg• kg-1•min-1), group L ( 0.2μg• kg-1•min-1) improves postoperative analgesia with no abvious side effects．
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