环氧合酶抑制剂对保乳根治术患者瑞芬太尼输注引起痛觉超敏的影响  

Effects of COX Inhibition on Hyperalgesia Inducing by Remifentanil Infusion after Mastectomy

作　　者：许冬妮[1] 卢桠楠[1] 王志[1] 彭书崚[1] 

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,广东广州510120

出　　处：《中山大学学报（医学科学版）》2016年第3期423-427,432,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金面上项目(30772091)

摘　　要：【目的】观察环氧合酶-1抑制剂和环氧合酶-2抑制剂能否防治乳腺癌保乳根治术患者瑞芬太尼持续输注引起的痛觉超敏。【方法】选择年龄在30～65岁之间ASAⅠ～Ⅱ级择期在全麻下行单侧乳腺癌保乳根治术的女性患者64例为研究对象，按照预处理的不同随机分为完全空白对照组（C组），瑞芬太尼组（R组），COX-2抑制剂帕瑞昔布＋瑞芬太尼组（PR组），COX-1抑制剂酮咯酸＋瑞芬太尼组（KR组），每组各16例。C组患者手术全程输注等容量外观的生理盐水；R组患者在瑞芬太尼开始泵注前15min静脉注射同等容量和外观的生理盐水；PR组患者在瑞芬太尼开始泵注前15min静脉注射40mg帕瑞昔布钠；KR组患者在瑞芬太尼开始泵注前15min静脉注射30mg酮咯酸。观察指标包括拔管后5min（VASl）、15min（VAS2）、30min（VAS3）、60min（VAS4）的视觉模拟评分（VAS评分），拔管后追加补偿镇痛的剂量和次数。【结果】①R组VASl评分显著高于PR组、KR组和C组（P值分别为P〈0．001，P=0．035，P=0．020）；R组VAS2评分显著高于PR组和KR组（P值分别为P=0．001，P=0．024）。各组间VAS3和VAS4评分不存在统计学差异。②PR组在VASl评分时点需要追加补偿镇痛的人次少于R组和KR组（P值分别为P=0．001，P=0．023），在VAS2评分时点需要追加补偿镇痛的人次少于R组（P=0．007）；在VAS3和VAS4评分时点需要追加补偿镇痛的人次各组问不存在统计学差异。【结论】①单侧乳腺癌保乳根治术患者持续输注瑞芬太尼能够引起痛觉超敏。②帕瑞昔布及酮咯酸预处理可减少瑞芬太尼持续输注引起的痛觉超敏。③帕瑞昔布组术后需要追加镇痛的患者明显少于酮咯酸组和瑞芬太尼组，提示COX-2抑制剂降低痛觉超敏的作用可能比COX-1的抑制剂更强。[Objective] To investigate the effects of COX-2 （parecoxib） and COX-1 （ketorolac） inhibition on hyperalgesia, which was induced by remifeutanil infusion in patients after masteetomy. [Methods] A total of 64 patients （aged 30-65, ASA Ⅰ～Ⅱ ） undergoing selective protective and radical operation of mastocarcinoma were enrolled in this study. The patients were equally divided into four groups in random. There were 16 patients in each group （Group C, Group R, Group PR, and Group KR）. Patients in group C and group R were given an equal volume of NS （0.9% NaCl Saline NS）. And patients in group C did not receive remifentanil infusion during the whole surgery procedure. For patients in group PR, Parecoxib 40 mg were administrated as pretreatment by intravenous injection before remifentanil infusion, while 30 mg Ketorolac for the patients in group KR. The degree of patients＇ postoperative pain after extubation was evaluated at four time spots （using VAS score）. The dose and frequency of analgesic drugs supplement were observed and recorded. [ Results ] （1）The VAS1 score in group R is remarkably higher than that in group C, group PR and KR （P = 0.020, P 〈 0.001 ,P = 0.035）. The VAS2 score in group is statistically higher than that of group PR and KR （P = 0.001, P = 0.024）. The VAS3 and VAS4 scores among the four groups were not statistically different. （2）The need of analgesics in group PR at VAS1 was remarkably less than that in group R and KR （P = 0.001, P = 0.023）. And the need of analgesics in group PR at VAS2 was remarkably less than that in Group R （P = 0.007 ）. The need for analgesics among four groups at VAS3 and VAS4 were not statistically significant. [Conclusion] （1）Infusion of Remifentanil during mastectomy can elicit pain sensitivity owing to opioid- induced hyperalgesia （OIH）. （2）Pretreatment with parecoxib or ketorolac can attenuate OIH in some extent. （3）Compared with Group KR, the patients in Group PR needed less supplementary analgesi

关 键 词：痛觉超敏 瑞芬太尼 帕瑞昔布 酮咯酸 

分 类 号：R441.1[医药卫生—诊断学]