超低剂量纳洛酮对大剂量瑞芬太尼诱发病人术后痛觉过敏的影响  

Effect of ultra-low dose naloxone on postoperative hyperalgesia induced by large dose remifentanil

作　　者：武林鑫[1] 段晓芸[1] 周芹[1] 熊玮[1] 黄雄庆[1] 

机构地区：[1]中山大学附属第一医院麻醉科,广州市510080

出　　处：《中华麻醉学杂志》2013年第2期145-147,共3页Chinese Journal of Anesthesiology

基　　金：广东省自然基金（10151008901000119）;广东省科技计划（20078031500004）

摘　　要：目的评价超低剂量纳洛酮对大剂量瑞芬太尼诱发病人术后痛觉过敏的影响。方法择期行胃肠外科开腹手术病人40例，年龄18～64岁，ASA分级I～Ⅲ级，采用随机数字表法，将其分为2组（n=20）：大剂量瑞芬太尼组（R组）和超低剂量纳洛酮组（N组）。麻醉诱导后，R组切皮时以0．25μg·kg-1·min-1的速率开始静脉输注瑞芬太尼，术中根据血流动力学调整，每次增减幅度为0．05μg·kg-1·min-1，吸入1．2％-1．5％七氟醚；N组静脉输注瑞芬太尼同时以0．1μg·kg-1·h-1的速率静脉输注纳洛酮，关腹膜时停止输注，其余处理同R组。术毕人麻醉恢复室（PAcu）90min，按需给予吗啡，离开PACU即采用吗啡病人自控静脉镇痛。记录第一疼痛时间，于术后15、30、60、90min、2、6、24、48和72h时记录累计吗啡用量及恶心、呕吐、瘙痒等不良反应的发生情况。结果与R组比较，N组术后各时点累计吗啡用量减少，第一疼痛时间延长，术后恶心发生率降低（P〈0．05），呕吐和瘙痒发生率比较差异无统计学意义（P〉0．05）。结论术中静脉输注超低剂量纳洛酮（0．1μg·kg-1·h-1）可减轻大剂量瑞芬太尼诱发的病人术后痛觉过敏。Objective To evaluate the effect of ultra-low dose naloxone on postoperative hyperalgesia caused by large-dose remifentanil.Methods Forty ASA Ⅰ -Ⅲ adult patients, scheduled for gastrointestinal sur- gery, were randomly assigned into 2 groups （ n = 20 each） ： large dose remifentail group （group R） and ultra-low dose naloxone group （group N）. Anesthesia was induced with iv injection of remifentanil, propofol and cisatracuri- um and maintained with inhalation of sevoflurane and infusion of remifentanil. The patients were tracheal intubated and mechanically ventilated. In group R, remifent＇anil was infused at a rate of 0.25 μg. kg- 1. min-1 starting from the beginning of skin incision. The infusion rate was adjusted according to hemodynamics during operation and sub- sequently increased/decreased by 0.05 μg .kg-1.min-1 each time. In group N, naloxone was infused at 0.1 μg. kg-1. h-1 while infusing remifentanil, naloxone infusion was stopped at the beginning of peritoneum closure and the other treatments were similar to those previously described in group R. All patients were sent to post-anes- thesia care unit after surgery and stayed there for 90 min. Morphine was given when need. The patient-controlled intravenous analgesia was used for postoperative analgesia after leaving post-anesthesia care unit. The first pain time was calculated. The morphine consumption and complications such as nausea, vomiting and pruritus were recorded at 15, 30, 60 and 90 min and 2, 6, 24, 48 and 72 h after surgery. Results Compared with group R, the morphine consumption was significantly reduced at each time point after surgery, the first pain time was pro- longed, and incidence of nausea was decreased （ P 〈 0.05）, while no significant change was found in the inci- dence of vomiting and prutirus in group N （P 〉 0.05 ）. Conclusion Infusing ultra-low dose naloxone （0.1μg. kg-1 .h-1） during operation can attenuate postoperative hyperalgesia caused by large-dose remifentanil in pa- tients.

关 键 词：纳洛酮 哌啶类 痛觉过敏 疼痛 手术后 

分 类 号：R614[医药卫生—麻醉学]