大鼠开胸术后慢性疼痛的预测指标  

Predictors of chronic post-thoracotomy pain in rats

作　　者：朱阿芳[1] 申乐[1] 许力[1] 陈唯韫[1] 吴树彬[1] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730

出　　处：《基础医学与临床》2017年第8期1128-1132,共5页Basic and Clinical Medicine

摘　　要：目的观察疼痛时弥散性伤害抑制性控制(DNIC)的动态变化,对术前DNIC、术后急性疼痛能否作为术后慢性胸痛的预测指标进行初步研究。方法术前检测大鼠DNIC,建立开胸术后慢性疼痛模型,分组为空白组(n=10)、假手术组(n=10)、模型组(n=20),连续监测术后1、3、6、9、12、15、18和21 d的机械痛阈、冷痛阈及DNIC。结果模型组大鼠中,11只发展为慢性疼痛组(CPTP组),9只在经历急性疼痛后痛觉恢复正常(non-CPTP组)。与CPTP组比较,non-CPTP组术前DNIC减弱(P<0.05),术后6 d切口附近机械痛阈值及冷痛阈值更低(P<0.05)。与术前DNIC相比,模型组术后急性疼痛时期(术后3 d)DNIC减弱(P<0.05),CPTP组术后21 d DNIC持续减弱(P<0.05),而non-CPTP组DNIC恢复正常。结论术前DNIC及术后6 d急性疼痛程度是开胸术后慢性疼痛的两项危险因素;疼痛急性期,个体DNIC减弱,痛觉恢复正常时,个体DNIC水平也渐趋恢复正常。Objective A rat model of chronic post-thoracotomy pain is used to study whether acute pain and pre- operative diffused noxious inhibitory controls （DNIC） can predict chronic pain and how DNIC changes when pain maintains. Methods Rats were randomly divided into three groups：naive group, sham group and model group. DNIC was constantly assessed in individual rats, along with each animal＇s mechanical hyperalgesia and cold allo- dynia after thoraeotomy. Results In model group, the incidence of chronic post-thoraeotomy pain was 55% （ 11 of 20） , which was named CPTP group, and the other 9 rats without chronic pain was defined as non-CPTP group. The pre-operative DNIC was significantly weaker in CPTP group with lower mechanical threshold on 6 days after surgery and higher cold sensitivity on 6 days after surgery comparing with non-CPTP group. In the acute pain phase （day 3） , DNIC was decreased in both CPTP group and non-CPTP group as compared with pre-operative period. Besides, DNIC was recovered in non-CPTP group while kept impaired in CPTP group on 21 days after surgery. Conclusions Pre-operatively assessed DNIC efficiency and acute post-operative pain intensity were two independent predictors for CPTP. DNIC was decreased both in acute pain and chronic state, while returned to nor- mal when pain sense was normal.

关 键 词：开胸术后慢性疼痛 弥散性伤害抑制性控制 急性疼痛 预测指标 

分 类 号：R614[医药卫生—麻醉学]