Chronic postsurgical pain (CPSP) is one of the major medical problems facing society, often with an adverse impact on a patient's quality of life after surgery. Although multimodal analgesia has been implemented in the perioperative period, some patients inevitably transit from acute to chronic pain (APSP). Individual differences among patients may be involved in the occurrence and development of CPSP. This review summarizes the risk factors that may cause postoperative CPSP from possible influence factors, including demographic characteristics such as age, gender, obesity, and smoking; the possible perioperative variables such as preoperative CPSP, quantitative sensory testing, type or modality of surgery, APSP, postoperative radiation therapy, and chemotherapy; psychological factors such as depression, anxiety, pain catastrophizing, and expected pain; and genetic factors, mainly referring to gene polymorphisms. Identifying these risk factors early can help identify high-risk patients and actively implement individual analgesic administration.

Objective To investigate the effect of esketamine combined with ketorolac tromethamine in preventing remifentanil-induced hyperalgesia.Methods Sixty patients undergoing elective laparoscopic total hysterectomy under general anesthesia were randomly assigned into two groups with 30 cases each. The patients of group EK received intravenous ketorolac tromethamine 15 mg on 20 minutes before induction of anesthesia and esketamine 0.125 mg/kg on 10 minutes before skin incision. The patients of group C were intravenously injected with the same volume of normal saline at the time points. The mechanical pain thresholds around the incision and medial dominant arm were measured before operation and at 12,24 and 48 hours after operation. The resting and cough pain numerical rating scale（NRS） scores at 3,6,12,24 and 48 hours after operation were recorded. The sufentanil consumption during 0-6,7-12,13-18,19-24 and 0-24 hours after operation and the first time of analgesic use were recorded. The adverse reactions within 48 hours after operation were observed.Results The mechanical pain thresholds around the incision and medial dominant arm were lower in group C at 12, 24 and 48 hours after operation, and those were lower in group EK at 48 hours after operation than those before operation（P＜0.05）. Compared with group C, the mechanical pain thresholds around the incision and medial dominant arm were increased at 12 and 24 hours after operation, resting NRS scores were decreased at 3, 6 and 12 hours after operation, cough NRS scores were decreased at 3, 6, 12 and 24 hours after operation, sufentanil consumptions were decreased during 0-6,7-12,13-18,19-24 and 0-24 hours after operation, and the first time of analgesic use was prolonged in group EK（P＜0.05）. The incidence of adverse reactions after surgery was not significantly different between the two groups（P＞0.05）.Conclusion Esketamine combined with ketorolac tromethamine can effectively prevent remifentanil-induced hyperalgesia after laparoscopic total hysterectomy without increasing adverse reactions.

Objective:To evaluate the effectiveness of esketamine during perioperative anesthesia for acute and chronic pain after cesarean section.Methods:One hundred and fifty patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned into 2 equal groups ( n=75) using a random number table: esketamine group (group E) and control group (group C). Subarachnoid block was administered with 9-11 mg of hyperbaric bupivacaine with 0.33% glucose concentration. After the delivery of the fetus, 0.15 mg/kg (1 mg/ml) esketamine was pumped intravenously for 30 min in the group E, while the same dosage of normal saline was administered in the group C. Furthermore, patients received an intravenous patient controlled intravenous analgesia (PCIA) pump after surgery (100 μg sufentanil + 1.25 mg/kg esketamine + 8 mg ondansetron for the group E, 100 μg sufentanil + 8 mg ondansetron for the group C). Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in the initial time of esketamine administration, and 5, 15 min, and 30 min after administration. The pain Numerical Rating Scale (NRS) score at rest and during coughing were recorded at 2, 6, 12, 24 h and 48 h after surgery. The first analgesic time and cumulative sufentanil consumption were recorded at 0-12 h, 12-24 h, 24-48 h, 0-24 h and 0-48 h after surgery. Moreover, we recorded the incidence of chronic pain at 3 and 6 months after surgery. Results:There were no significant differences in HR, SBP and DBP between the two groups immediately after administration of esketamine and 5, 15 min and 30 min after administration (all P>0.05). At rest or during coughing, the pain NRS score were significantly lower at 2, 6 h, and 12 h postoperatively in group E compared to group C (all P<0.05). The time to first analgesia in group E was significantly longer than the group C [(176.8±18.3)min vs (148.5±16.9)min, P<0.05]. The cumulative sufentanil consumption was significantly lower in group E during 0-12 h, 12-24 h, 0-24 h and 0-48 h postoperatively than in group C (all P<0.05), but there was no statistical significance between the two groups at 24-48 h ( P>0.05). There were no significant difference between the two groups in the incidence of chronic pain at 3 months and 6 months after surgery ( all P>0.05). The incidence of chronic pain in group E was lower than that in group C at 3 months [13.4%(9/67) vs 18.8%(13/69), P=0.392] and 6 months [10.7%(6/56) vs 16.1%(10/62), P=0.391], but the difference was not statistically significant. Conclusions:Perioperative administration of esketamine provided superior short-term analgesia after cesarean section and did not increase the psychotomimetic adverse event rate. However, the development of chronic pain was not restrained.

目的 探讨苯磺酸瑞马唑仑及丙泊酚用于无痛人工流产术患者麻醉中的效果及安全性.方法 回顾性分析86例需行无痛人工流产术患者为研究对象,根据采用的麻醉方式不同分为研究组和对照组,每组43例.研究组患者给予注射用苯磺酸瑞马唑仑进行麻醉,对照组患者静脉注射丙泊酚进行麻醉.观察两组心率(HR)与平均动脉压(MAP)水平于麻醉前(T0)、麻醉后1min(T1)、宫颈口扩张时(T2)、清除宫内妊娠物时(T3)以及患者意识恢复时(T4)的具体情况,比较两组药物起效时间、恢复意识时间、镇静量表(Ramsay)评分、视觉模拟评分法(VAS),并记录两组术后不良反应.结果T0时,两组HR、MAP水平比较,差异无统计学意义(P＞0.05);T1、T2、T3时,两组HR、MAP水平均低于T.时,但研究组均高于对照组,差异均有统计学意义(P＜0.05);T4时,研究组HR、MAP水平均高于对照组,差异均有统计学意义(P＜0.05).研究组VAS评分低于对照组,差异有统计学意义(P＜0.05);两组药物起效时间、Ramsay评分、恢复意识时间比较,差异均无统计学意义(P＞0.05).研究组不良反应发生率低于对照组,差异有统计学意义(P＜0.05).结论 无痛人工流产患者采用苯磺酸瑞马唑仑麻醉,能减轻生命体征波动和术后宫缩疼痛,其麻醉效果与丙泊酚相似,患者可较快苏醒,但该药物不良反应发生风险较丙泊酚低,安全性较高,值得临床推广与应用.

急性术后疼痛(APP)是患者受到手术刺激后出现的一系列生理、心理及行为反应等,主要集中在术后24～72 h,常持续4～6 d.APP严重影响手术预后,而导致患者APP治疗不充分的原因较多,因此,APP的管理重点在于对疼痛的评估和预防,充分理解和掌握APP危险因素和疼痛程度预测方法对于APP的管理十分必要.APP的危险因素包括人口社会学因素、心理因素、术前疼痛及阿片类药物的使用、手术、麻醉相关因素等.APP程度预测方法包括镇痛监测指标、局部浸润麻醉疼痛评分、外周静脉针留置疼痛评分、定量感觉检查、疼痛敏感度问卷、脑电图等.全文主要就其在急性术后疼痛危险因素和疼痛程度预测方法的进展进行综述,为临床应用提供参考.

目的 探讨急性前循环大血管闭塞性卒中机械取栓(MT)术中血压参数对于功能预后的影响.方法 对164例接受MT治疗的急性前循环大血管闭塞性卒中患者,依据患者治疗后90 d改良Rankin量表(mRS)分为预后良好组(0～2分,85例)和预后不良组(3～6分,79例).分析2组患者的基线资料及临床资料,术中血压参数包括基线收缩压(SBP)及平均动脉压(MAP)、术中SBP和MAP的最高值、最低值、最高最低差值、均值、标准差、连续变异度、术中SBP下降超过基线值20％及术中MAP低于60 mmHg的例数,并进一步对患者预后的影响因素进行多因素Logistic回归分析.结果 164例患者中,预后良好85例.多因素Logistic回归分析显示,基线SBP增高、术中MAP低于60 mmHg均为预后良好的危险因素;术中MAP min增高则为预后良好的保护因素(P＜0.05).结论 MT术中需重视基线收缩压的控制,但也要避免过度降压,特别是平均动脉压不应低于60 mmHg.

目的 分析B超引导下腋路、肌间沟及锁骨上不同入路神经阻滞在桡骨远端手术中的应用效果.方法 将我院收治的90例桡骨远端骨折患者随机分为A组、B组及C组,每组30例;A组采用肌间沟入路臂丛神经阻滞术治疗,B组采用腋路臂丛神经阻滞术治疗,C组采用锁骨上入路臂丛神经阻滞术治疗;观察三组患者操作时间及手术时间;统计所有患者痛觉消失时间,操作完成后采用针刺法对神经支配区痛觉进行评价;对患者各神经支配的感觉阻滞进行评价;分析患者局部麻醉药中毒、血肿、膈神经阻滞、术中止血带反应等并发症情况.结果 三组操作时间及手术时间差异无统计学意义(P＞0.05);三组患者前臂外侧皮神经及桡神经分支痛觉消失时间差异无统计学意义(P＞0.05),B组患者前臂内侧皮神经、尺神经及正中神经分支痛觉消失时间低于A组及C组(P＜0.05);B组患者麻醉效果优良率高于A组及C组(P＜0.05);三组患者镇痛持续时间差异无统计学意义(P＞0.05);三组患者并发症差异无统计学意义(P＞0.05).结论 相较于前臂内侧皮神经、尺神经阻滞,腋路臂丛神经阻滞效果更好.

羟考酮是由蒂巴因衍生物制成的一种半合成阿片μ和κ受体激动药,临床上广泛应用于术后镇痛.近年来,由于羟考酮镇痛作用强,免疫抑制轻,对胃肠道影响小,目前已逐步应用于全身麻醉的各个环节中,包括术前、术中及术后.本文综述羟考酮在全身麻醉中的应用进展.

Objective:To observe the hemodynamic change and inhibitory effect on stress response of oxycodone during induction, maintenance and resuscitation period of general anesthesia in patients undergoing gastric cancer surgery.Methods:60 patients with general anesthesia undergoing elective gastric cancer from March 2018-March 2019 in No.904 Hospital were selected. According to the random number table method, they were randomly divided into two groups ( n=30): Oxycodone group (group O) and Fentanyl group (group F). The anesthesia was induced by intravenous oxycodone 0.3 mg/kg (group O) or fentanyl 3 μg/kg (group F), propofol 2 mg/kg and cisatracurium 0.25 mg/kg. Oxycodone (group O) or fentanyl (group F) with sevoflurane were used for maintenance of general anesthesia. The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction (T 0), immediately intubation (T 1), 1 min (T 2) and 5 min (T 3) after intubation, immediately skin incision (T 4), surgery for 1 h (T 5), the end of operation (T 6) and 1 min (T 7) and 5 min (T 8) after extubation. The concentration of glucose (Glu), cortisol (Cor), epinephrine (E) and norepinephrine (NE) were detected in time T 0,T 2, T 4,T 5 and T 7. The time of extubation and the visual analogue scale (VAS) scores after extubation and 30 min after entering postanesthesia care unit (PACU) were recorded. The incidence of cough during induction, dysphoria during extubation and the adverse effects such as nausea, vomit and respiratory depression during PACU were also observed. Results:There were no significant difference between two groups in MAP and HR at the time point from T 0 to T 8 ( P>0.05); there were no significant difference about concentrations of Glu, Cor, E and NE at the time point of T 0,T 2,T 4,T 5 and T 7 ( P>0.05). Extubation time and VAS scores of 30 min after entering PACU in group O were significantly lower than those of group F ( P<0.05). Meanwhile, the incidences of cough during induction, dysphoria during extubation and respiratory depression in group O were significantly lower than in group F ( P<0.05). There was no significant difference in the incidence of nausea and vomiting ( P>0.05). Conclusions:Oxycodone can be safely and effectively used for induction and maintenance of general anesthesia in gastric cancer surgery, inhibit intraoperative stress response, and improve the quality of recovery period.

Objective To observe the effect of oxycodone for postoperative patient-controlled intravenous analgesia of laparoscopic total hysterectomy with or without background infusion.Methods Seventy five patients, aged 40-65 years, BMI 18-24 kg/m2, ASA physical statusⅠ orⅡ, scheduled for elective laparoscopic total hysterectomy surgery under general anesthesia were randomly assigned into 3 equal groups (n = 25 each) using a random number table:morphine group (group M), oxycodone with background infusion group (group O1) and oxycodone without background infusion group (group O2).The anesthesia was induced by intravenous fentanyl 4μg/kg, propofol 2-2.5 mg/kg and cisatracurium 0.2 mg/kg.Group M was given morphine 50 mg+ondanstron 8 mg in100 ml normal saline, groups O1 and O2 were given oxycodone 50 mg+ ondanstron 8 mg in 100 ml normal saline.The PCIA pump of group M and group O1 were set up with a 0.5 ml bolus dose, a 5 min lockout interval and background infusion at a rate of 2 ml/h.Group O2 was set up with a 4 ml bolus dose, a 5 min lockout interval and without background infusion.The NRS scores of three groups at 4, 8, 12, 24 and 48 hafter operation were recorded.The total morphine or oxycodone consumption, and the number of rescue analgesia within 48 hafter surgery were recorded.The adverse events within 48 hafter surgery were also observed.Results Compared with group M, the NRS scores at rest were significantly decreased at 4, 8, and 12 hafter operation (P<0.05), and the NRS scores at movement were significantly decreased at 4 and 8 hafter operation (P<0.05), and the number of rescue analgesia within 48 hafter surgery was significantly decreased in groups O1 and O2 (P<0.05).The total analgesic consumption and the incidence of adverse event within 48 hafter surgery in group O2 were significantly lower than those in groups M and O1 (P<0.05).Conclusion Compared with morphine, oxycodone for patient-controlled intravenous analgesia can obtain more satisfactory effects after laparoscopic total hysterectomy surgery.Meanwhile, the total consumption of oxycodone and the incidence of nausea and vomiting are significantly decreased.

Background The postoperative pain after total knee arthroplasty (TKA) is the main reason to affect the early postoperative function exercise of the knees. Postoperative analgesia is a challenging task for medical personnel because it requires not only good analgesia effect, but also a minimal impact on joint movement function. The regional anesthesia techniques provides a good direction for the management of postoperative pain. Objective To introduce the advantages and risks of various regional pain management after TKA and review the new research advances to provide new clues for pain management after TKA. Content Femoral nerve block (FNB) provides effective postoperative analgesia for patients recovering from TKA. Whether using the sciatic nerve block additionally as the clinical treatment method or not is still in disputation. Lumbar epidural block can obviously increase the incidence of epidural hematoma in orthopedic patients. Femoral nerve block can provide a similar effect and greater satisfaction. In the meantime, comparing with the epidural pain management, it also can obviously reduce the risk of adverse reactions occurrence. Local infiltration analgesi (LIA) and adductor canal block have hope to get enough pain control and with fewer side effects. Trend LIA management and adductor canal block may replace FNB as pain management after TKA, but it still need further clinical trials to verify current results.

Objective To observe the efficacy of oxycodone under no background dose in patient-controlled intravenous analgesia (PCIA)after caesarean surgery. Methods Sixty patients undergoing selective cesarean section were randomly categorized into two groups using random schedule table(n=30): group morphine(group M) and group oxycodone(group O), all patients were aged between 20 to 35 years and of ASA classⅠ, Ⅱ.Fifty milligrams of morphine was delivered in group M, while 50 mg oxycodone was delivered in group O.Ondansetron 8 mg was added to each group.PCIA was set on demand mode without loading dose or background infusion.In both groups,drugs were diluted to 100 ml with normal saline,and 4 ml bolus dose with 5 min lockout interval was set.At 4, 8, 12 h and 48 h after surgery, VAS was assessed, including VAS at rest, VAS at motion and VAS at uterine contraction. Total doses of the drug delivery within postoperative 48 h and the number of patient controlled analgesia(PCA)were recorded,postoperative nausea and vomiting and patient satisfaction were also evaluated. Results At 4, 8, 12 h and 24 h after surgery, VAS at uterine contraction in group O was significantly lower than VAS of group M(P<0.05).No significant differences were detected between the two groups in VAS at rest and motion at all time points(P>0.05).At 48 h after surgery,total doses of PCIA drugs,the number of PCA and the incidences of side effects were significantly lower in group O than these parameters in group M (P<0.05). The overall patient satisfaction degree in group O was significantly higher than patient satisfaction degree in group O (P<0.05). Conclusions Both oxycodone and morphine are effective for pain relief after cesarean section when PCIA is set on bolus mode.However,compared with morphine,oxycodone exhibited significantly better effects on uterine contraction,pain relief and patient satisfaction.

临床上有很多种分娩镇痛方法,硬膜外分娩镇痛是目前最为成熟的分娩镇痛技术[1],其优点是镇痛完善,但是椎管内穿刺易造成损伤,尤其是穿刺易造成腰背痛[2].研究[3-4] 指出,与椎管内镇痛相比,瑞芬太尼用于分娩镇痛具有给药迅速、操作简单、创伤小、不引起发热等特点.研究[5-6] 推荐静脉持续输注瑞芬太尼的剂量为0.05 μg/(kg·min).本研究探讨瑞芬太尼静脉输注用于分娩镇痛的半数有效剂量,现报告如下. 1 资料与方法 1.1 一般资料 选择本院2015年1-12月符合纳入条件的初产妇共52例,年龄20~29岁,体质量40~99 kg,身高150~170 cm,孕周大于37周.ASA分级Ⅰ~Ⅱ级,产妇宫口开大小于3 cm.产妇自愿接受瑞芬太尼静脉镇痛,按照医院伦理委员会的批文,均签署麻醉告知同意书且告知PCA泵的使用方法.

Objective To evaluate the efficacy of intra-articular injection of ropivacaine mixed with fentanyl or dexmedetomidine for postoperative analgesia after arthroscopic knee surgery.MethodsFifty patients underwent selective arthroscopic knee surgery were randomly and equally assigned into two groups.Group RF received fentanyl 50μg and 0.25% ropivacaine and group RD received dexmedetomidine 1μg/kg and 0.25% ropivacaine,which were intra-articularly injected in a total volume of 20ml.VAS pain scores at rest and on movement were evaluated at 2,4,6,8,10 and 12 hours after surgery.The consumption of butorphanol in 24 hours after surgery was calculated.The adverse effects were observed.Results VAS pain scores at rest and on movement at all time points in 10 hours were lower in two groups,which were not significantly different between two groups(P>0.05).The consumption of butorphanol in 24 hours after surgery in group RF was similar to that in group RD(P>0.05).No obvious adverse effects were seen in two groups.Conclusion Intra-articular injectrion of ropivacaine combined with fentanyl or dexmedetomidine can provide an effective postoperative analgesia in the patients underwent arthroscopic knee surgery.

Dexmedetomidine (Dex) is a novel and highly selective o2-adrenoceptor agonist,it has anxiolytic,antisympathetic and certain analgesic effects,its sedative effect can lead to mimic natural sleep.Dex is widely applied in mechanical ventilation,invasive procedures and perianesthesia with other drugs by intravenous route.Recent basic and clinical researches show that Dex can be applied safely and effectively with local anesthetics in regional block,to improve anesthetic effect,promote stable hemodynamics and optimize postoperative analgesia.

Background Dexmedetomidine (Dex) is a novel and highly selective or2 adrenoceptor agonist with sedative,analgesic,anxiolytic and antisympathetic properties.It is applied widely in clinic and tends to be diversified on administration route.Objective To review and summarize the relevant studies and to discuss the application prospect of Dex on administration route.Content We elucidated the safety of Dex and the influence of local anesthetic effect on spinal canal,peripheral nerve and intraarticular.In addition,we also evaluated the safety and validity of drug delivery by intravenous,oral,intramuscular injection,subcutaneous,intranasal and rectal.Trend Dex has a broad prospect in clinical application because of diversity on administration route.

Objective To compare the efficacy of intra?articular dexmedetomidine or morphine mixed with ropivacaine for postoperative analgesia after arthroscopic knee surgery?Methods Sixty ASA physical status I or II patients scheduled for elective arthroscopic knee surgery were randomly assigned into 3 equal groups using a random number table?The group R received 0?25% ropivacaine, and the group RD received 1 μg/kg dexmedetomidine and 0?25% ropivacaine,and the group RM received 2 mg morphine and 0?25% ropivacaine intraarticularly in a total volume of 20 ml?Visual analogue scales( VAS) scores when the patients actively flexed the operated knee to 90° were recorded at 2, 4, 8, 12, 18 and 24 h after surgery?The analgesic duration and consumption of fentanyl at 24 h after surgery were recorded?The complications such as bradycardia,hypotension, nausea,vomit,cutaneous pruritus and uroschesis were followed up?Results At 8 and 12 h after surgery,VAS scores were significantly lower in group RD ( ( 3?23 ± 0?45 ) points, ( 3?18 ± 0?47 ) points ) and RM ( ( 3?20 ±0?46) points,(3?13±0?45) points) than in group R((4?01±0?74) points,(3?93±0?71) points),and at 18 and 24 h after surgery,they were significantly higher in group R((3?85±0?62) points,(3?72±0?57) points) and RD((3?83±0?57) points,(3?71±0?55) points) than in group RM((3?07±0?43) points,(3?02±0?41) points),and there was significant difference(F between groups=124?65,P=0?021,F inner grouP=11?65,P=0?004,F across groups=67?65,P=0?024)?The analgesic duration was significantly different in three groups (F=45?78,P<0?001),and in group RD((668?3±133?4) min) and RM((1 412?8±275?67) min) was significantly longer than in group R(402?3±81?5) min,P<0?05),and the group RM was longer than the group RD( P<0?05)?The consumption of fentanyl at 24 h after surgery was significantly different in three groups ( F=34?47,P<0?001),and it was significantly lower in group RD((32?6±7?3) μg) and RM((12?8±3?7) μg) than in group R((151?3±28?5) μg,P<0?05),and the group RM was lower than the group RD(P<0?05)?No significant side effects were found?Conclusion Intra?articular dexmedetomidine or morphine all can improve the efficacy of ropivacaine for postoperative analgesia after arthroscopic knee surgery,while morphine is superior to dexmedetomidine.

目的 探讨超声引导股神经加腘窝入路坐骨神经阻滞复合全身麻醉在胫骨骨折内固定手术中的应用.方法 择期行胫骨骨折内固定手术的患者60例,随机分为两组,每组30例.A组全身麻醉,B组全麻诱导后行超声引导下股神经加胭窝入路坐骨神经阻滞.记录患者丙泊酚用量、唤醒时间、拔管时间、拔管后10 min Ramsay镇静评分、拔管后30 min VAS疼痛评分及术后并发症情况;记录术后24 h患者满意度.结果 B组患者术中丙泊酚用量明显少于A组(P＜0.05);B组唤醒时间和拔管时间明显短于A组(P＜0.05).拔管后30 min,B组VAS疼痛评分明显低于,术后24 h患者满意度明显高于A组(P＜0.05).结论 全麻复合超声引导股神经加胭窝入路坐骨神经阻滞可明显减少术中全麻药用量,有利于术后快速苏醒,并且可以减轻早期术后疼痛,减少术后镇痛药的使用.

目的 评估持续收肌管阻滞对全膝关节置换术(total knee arthroplasty,TKA)后早期活动的影响.方法 接受单侧 TKA手术患者60例,男24例,女36例,年龄60～75岁,体重40～75 kg,ASAⅡ或Ⅲ级.随机分为持续收肌管阻滞组(A组)和持续股神经阻滞组(F组),每组30例.A组接受持续收肌管阻滞,F组接受持续股神经阻滞.记录TKA术后第1、2天每天总的步行距离,膝关节主动弯曲和伸直度,每日阿片类药使用量,疼痛评分及住院时间.结果 A组术后第1天和第2天步行距离分别为(36±5)m和(60±10)m,F组术后第1天和第2天步行距离分别为(4.5±3)m和(21±5)m,A组明显长于F组(P＜0.05).A组术后第1天膝关节主动弯曲度大于F组(P＜0.05).两组患者膝关节主动伸直度、每日阿片类药使用量、疼痛评分和住院时间等差异均无统计学意义.结论 持续收肌管阻滞可促进TKA术后早期行走.

目的:观察地佐辛及右美托咪定复合曲马多用于腹腔镜胆囊手术术后患者自控静脉镇痛的效果.方法:选取60例择期全麻下行腹腔镜胆囊手术的患者,ASA分级Ⅰ～Ⅱ级,随机均分三组,A组为曲马多组,B组为地佐辛复合曲马多组,C组为地佐辛、右美托咪定复合曲马多组.采用VAS评分及BCS评分分别评价三组术后4h(T1)、8 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)疼痛程度和舒适度,记录术后48 h曲马多用量、自控镇痛按压次数及不良反应发生率.结果:T1、T2、T3各时点VAS评分A组明显高于B、C组(P＜0.05),T4、T5时点C组低于A、B组(P＜0.05);T1、T2、T3各时点BCS评分A组明显低于B、C组(P＜0.05),T4、T5时点C组高于A、B组(P＜0.05);术后48 h自控镇痛按压次数A组多于B、C组(P＜0.05);术后48 h曲马多用量C组明显少于A、B组(P＜0.05);与A、B组相比,C组恶心、呕吐发生率低(P＜0.05),多汗、头晕及心动过缓等发生情况无差异(P＞0.05).结论:地佐辛超前镇痛可增强曲马多腹腔镜胆囊手术术后自控静脉镇痛效果,再辅用右美托咪定可减少曲马多用量,同时降低其恶心、呕吐的发生率.