术前疼痛敏感度与术中应激反应及镇痛药物消耗量的关系  

Relationship between preoperative pain sensitivity and stress response and analgesic drug consumption during operation

作　　者：罗炜[1] 王迎斌[1] 李涛[1] 张双银[1] 

机构地区：[1]兰州大学第二医院麻醉科,兰州市730030

出　　处：《实用疼痛学杂志》2016年第4期267-270,共4页Pain Clinic Journal

摘　　要：目的观察术前疼痛敏感度与术中应激反应及镇痛药物消耗量的关系。方法选取我院择期行开腹手术患者77例，术前1d行疼痛敏感度测定，术中实施全凭静脉麻醉，记录患者痛阈和耐痛阈及手术时间，并观察诱导至插管后4min内、切皮至探查前丙泊酚消耗量；另对插管后4min内、切皮后4min内、探查后4min内和术中瑞芬太尼消耗量及各时段平均动脉压、心率变化进行分析，并分析痛阈、耐痛阈与上述指标的相关性。结果本组患者痛阈平均值为（1．6±0．6）mA，耐痛阈为（3．7±1．0）mA；手术时间平均为（78．6±12．3）min；相关性分析显示：耐痛阈与麻醉诱导开始至插管后4min、切皮开始至探查前丙泊酚消耗量以及插管、切皮、探查后4min内、术中瑞芬太尼消耗量均呈负相关，而与痛阈均无相关性；插管、切皮、探查、手术开始后30min、术毕等各时段MAP及HR值与耐痛阈呈负相关，而与痛阈无相关性。结论术前疼痛敏感度耐痛阈与术中应激反应及镇痛药物消耗量均呈负相关，而与痛阈无关。Objective To observe the relationships between preoperative pain sensitivity and stress response and analgesic drug consumption during operation. Methods Pain sensitivity in seventy-seven patients undergoing selective laparotomy was measured at 1 d before the operation, and the total intravenous anesthesia was carried out during the operation. The pain threshold, pain tolerance threshold and operation time were observed and recorded, and the propofol dosage from induction to 4 rain after intubation and from skin incision to exploration were observed. The remifentanil dosage within 4 min after intubation, within 4 min after skin incision, within 4 min after exploration and during operation and the changes of mean arterial pressure and heart rate at different time were recorded, then the relationships between the pain threshold and pain tolerance threshold and the indexes mentioned above were analyzed by Pearson Correlation Analysis. Results The mean pain threshold of patients was （1.6 ± 0.6） mA, and the pain tolerance threshold was （3.7 ± 1.0） mA in this group, with （78.6 ± 12.3） rain of mean operation time. The correlation analysis showed that the pain tolerance threshold was negatively related to the propofol dosage from induction to 4 min after intubation and from skin incision to exploration and the remifentanil consumption within 4 rain after intubation, within 4 rain after skin incision, within 4 rain of exploration and during operation, with no relationships to the pain threshold. The MAP and HR values at intubation, skin incision, exploration, intraoperative 30 min and at the end of operation were negatively related to pain tolerance threshold, with no relationships to the pain threshold. Conclusion The preoperative pain tolerance threshold shows negative correlations to stress response and analgesic drug consumption during operation, not to pain threshold.

关 键 词：疼痛敏感度 痛阈 应激反应 镇痛 丙泊酚 

分 类 号：R614[医药卫生—麻醉学]