不同剂量右美托咪定对瑞芬太尼诱发的术后痛觉过敏影响  

EFFECTS OF DIFFERENT DOSE OF DEXMEDETOMIDINE ON RATS WITH REMIFENTANIL INDUCED POSTOPERATIVE HYPERALGESIA

作　　者：黄晓玲[1] 邹毅[1] 单文燕[1] 潘冰冰[1] 孔高茵[1] 黄东[2] 

机构地区：[1]湖南省人民医院麻醉科,长沙410005 [2]中南大学湘雅三医院,长沙410013

出　　处：《中国疼痛医学杂志》2016年第9期655-658,共4页Chinese Journal of Pain Medicine

基　　金：湖南省卫生厅科技计划项目(B2011-074)

摘　　要：目的:探讨右美托咪定(dexmedetomidine,Dex)对瑞芬太尼(remifentanil,Ren)诱发的术后痛觉过敏大鼠脊髓p38丝裂原活化蛋白激酶(p38MAPK)表达的影响。方法:雄性SD大鼠60只,随机分为5组,每组12只:对照组(C组);切口痛组(I组);切口痛+Ren组(R组),输注Ren(l.0μg/kg)4 h;切口痛+Ren+大剂量Dex组(RD1组),输注Ren(l.0μg/kg)4 h的同时给予Dex 10μg/kg负荷量,再以10μg/kg持续输注4 h;切口痛+Ren+常规剂量Dex组(RD2组),输注Ren(l.0μg/kg)4 h的同时给予Dex 5μg/kg负荷量,再以5μg/kg持续输注4 h。于术前24 h,停药后2 h、6 h、24 h和48 h(T0-T4时点)以累积疼痛评分(CPS)评估大鼠疼痛强度。最后取大鼠腰段脊髓行免疫组织化学检测,观察p38MAPK的表达。结果:R组在T3-T4时点的CPS值较I组明显升高(P<0.05),而RD1组与RD2组在T1-T4时点的CPS值明显低于R组与I组(P<0.05),RD1组与RD2组组间CPS值相比无显著差异;R组p38MAPK染色实际灰度为132.83±7.32,显著高于其它各组(P<0.01);RD1组为69.87±6.17,RD2组74.57±7.11,均显著低于I组(91.43±5.76)(P<0.05),而RD1与RD2两组之间相比差异不显著(P>0.05),与C组(57.56±3.44)比较亦无统计学意义。结论:右美托咪定预防瑞芬太尼诱发的术后痛觉过敏机制与抑制脊髓p38MAPK表达有关,且与剂量无关。Objective： To investigate the effect of dexmedetomidine（Dex） on the activation of spinal p38 mitogen protein kinase in remifentanil（Ren） induced postoperative hyperalgesia rats. Methods： Sixty adult, male SD rats were randomly divided into five groups with twelve rats in each： Control group（C）; Incision pain group（I）; Remifentanil group（R）： rats were given intravenous remifentanil l.0 μg/kg continuously for 4 h; Large dosage of Dex group（RD1）： remifentanil was given the same dose of group R, meanwhile Dex was given at a rate of 10 μg/kg for 4 h after a loading dose of Dex10 μg/kg; Regular dosage of Dex group（RD2）： remifentanil was given the same dose of group R, meanwhile Dex was given at a rate of 5 μg/kg for 4 h after a loading dose of Dex 5 μg/kg. Incisions were made in all rats except those in group C. Cumulative pain score（CPS） was measured 24 h before plantar incision and 2, 6, 24 and 48 h after drug withdrawal. P38 MAPK positive cells in the spinal cord were examined using immunohistochemistry method. Results： The CPS of group R at T3-T4 was significantly higher than those of group I; The CPS of group RD1 and RD2 were significantly lower than those of group I and group R. There was no significant difference between RD1 and RD2. The actual gray density of p38 MAPK in group R（132.83±7.32） was significantly increased than that of the rest groups. The p38 MAPK expression in both group RD1（69.87±6.17） and RD2（74.57±7.11） were significantly lower than that of group I（91.43±5.76）, but there was no significant difference between these two groups, and did not have significant difference with group C（57.56±3.44）. Conclusion： Dex could prevent remifentanil induced hyperalgesia due to the inhibition of p38 MAPK in the spinal cord. There was no difference between a regular and a large dosage of Dex.

关 键 词：P38 MAPK 痛觉过敏 右美托咪定 切口痛 

分 类 号：R614[医药卫生—麻醉学]