NMDAR在瑞芬太尼引起痛觉过敏机制和防治的研究进展  

The Role of N-methyl-D-aspartate Receptor in the Mechanism and Prevention of Remifentanil Induced Hyperalgesia

作　　者：李燕[1] 王国年[1] 林鹰[1] 杨光[1] 徐德生[1] 

机构地区：[1]哈尔滨医科大学附属第三医院麻醉科,黑龙江哈尔滨150081

出　　处：《现代生物医学进展》2015年第6期1148-1150,1164,共4页Progress in Modern Biomedicine

基　　金：哈尔滨市科技创新人才研究专项资金(2012RFXXSO41)

摘　　要：阿片类药物引起痛觉过敏(opioid-induced hyperalgesia,OIH)是指暴露于阿片类药物的患者出现一种痛阈降低和对正常疼痛刺激的超敏反应为特点的感觉异常现象。瑞芬太尼是一种μ受体激动剂,且由于起效迅速,时量半衰期短而恒定,重复用药亦无蓄积,这些良好的药代动力学特点导致它发生的痛觉过敏现象也明显频于、强于其他阿片类药物。N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)激活在产生超敏现象中是非常重要的。但是关于NMDAR在瑞芬太尼诱发痛觉过敏的机制尚未完全清楚,仍然缺乏系统的预防和治疗方案。本文简要介绍了NMDAR,总结了NMDAR在瑞芬太尼引起痛觉过敏的机制中的作用,归纳了临床上一些NMDAR拮抗药物来预防瑞芬太尼引起的痛觉过敏现象,以期对后续的围术期的疼痛管理提供理论依据。Opioid-induced hyperalgesia（OIH） is the state of decreased sensory thresholds and increased sensitivity to normal pain stimulation induced by opioid exposure. Remifentanil is an ultra-short acting μ-opioid receptor agonist that is associated with predictable and rapid recovery independent of dose and duration of infusion. Shorter acting opioids cause more rapid and frequent hyperalgesia. The activation of N-methyl-D-aspartate receptor（NMDAR） has a critical role in the development of OIH. The involvement of NMDAR signaling underlying remifentanil-induced hyperalgesia have not been completely established, thus, there are no efficacious preventions or therapies for the problem. The review introduces background information on receptor, summariing the role of NMDAR in the remifentanil-induced hyperalgesia and some NMDAR antagonist clinical drugs to preventing the hyperalgesia phenomenon, providing a theoretical basis for follow-up of perioperative pain management.

关 键 词：瑞芬太尼 NMDAR 痛觉过敏 预防 

分 类 号：R614[医药卫生—麻醉学]