雷米芬太尼导致术后痛觉过敏的剂量依赖关系  

The dose-dependent relationship of remifentanil inducing postoperative hyperalgia

作　　者：汪芳俊[1] 万勇[1] 刘洋[1] 涂发平[1] 

机构地区：[1]川北医学院附属医院麻醉科,四川省南充市637000

出　　处：《临床麻醉学杂志》2009年第11期937-939,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察雷米芬太尼引起术后痛觉过敏的剂量依赖关系。方法择期腹部手术患者300例随机均分成五组。各组维持麻醉的雷米芬太尼剂量分别为0.1μg.kg-1.min-1(R0.1组)、0.2μg.kg-1.min-1(R0.2组)、0.3μg.kg-1.min-1(R0.3组)、0.4μg.kg-1.min-1(R0.4组)、0.5μg.kg-1.min-1(R0.5组)。分别于术前(T0)和静脉停止泵注雷米芬太尼后1 h(T1)、1.5 h(T2)、2 h(T3)、3 h(T4)、6 h(T5)、12 h(T6)、24 h(T7)、48 h(T8)应用机械压力法测定各组患者胫骨前皮肤的疼痛阈值,同时在T1～T8时记录患者VAS评分;记录患者术后镇痛药物的使用情况。结果R0.3、R0.4、R0.5组机械压力痛觉阈值T1～T5时较T0时明显降低(P<0.05或P<0.01),R0.4、R0.5组T6时仍然偏低(P<0.05)。T4～T8时五组VAS评分均低于T1时(P<0.05或P<0.01);T1～T6时R0.3、R0.4、R0.5组VAS评分较R0.1组明显升高(P<0.05或P<0.01),T7时R0.4、R0.5组VAS评分仍然偏高(P<0.05或P<0.01)。结论雷米芬太尼剂量达到0.3μg.kg-1.min-1时可以降低患者机械压力痛觉阈值,并导致痛觉过敏。Objective To observe the dose-dependent relationship remifentanil inducing postoperative hyperalgia. Methods Three hundred patients undergoing selective abdominal surgery under general anaesthesia were randomly divided into five groups with 60 cases each. Anesthesia was maintained with isoflurane inhalation, infusion of propofol 80 μg· kg^-1· min^-1, and remifentanil 0. 1 （group R0. 1 ）, 0.2 （group R0. 2 ）, 0. 3 （group R0. 3 ）, 0. 4 （ group R0. 4 ）, or 0.5 μg· kg^-1· min^-1 （group R0.5）. The pressure pain threshold（PPT） was evaluated before anesthesia（T0） and 1 h（T1 ）, 1.5 h （T2）, 2 h（T3）, 3 h（T4）, 6 h（T5）, 12 h（T6）, 24 h（T7）, 48 h（T8） after stopping infusion of remifentanil. The VAS scoring was performed and the use of postoperative analgesic was recorded. Results Compared to To, the PPT was markedly decreased at T1-T5 in group R0. 3 and at T1-T6 in group R0.4 and R0.6 （P 〈0. 05 ）. The VAS scores were increased significantly more in group R0. 3 than those in group R0. 1 at T1-T6 after stopping infusion of remifentanil（P〈0.05 or P〈0. 01）. The VAS scores was increased more significantly in group R0.1 and R0.5 than those in group R0.1 at T1 -T7 （P〈 0. 05 or P〈0. 01）. Conclusion The PPT was decreased significantly when the dosage of remifentanil infusion reached 0. 3 μg· kg^-1· min^-1 or more.

关 键 词：雷米芬太尼 痛觉过敏 

分 类 号：R614[医药卫生—麻醉学]