不同浓度瑞芬太尼致痛觉过敏患者血清中强啡肽水平  

The Effects of Different Concentrations of Remifentanil on Hyperalgesia and Serum Dynorphin Levels

作　　者：周丽丽 王贵龙 高鸿[3] 刘艳秋[3] 郭耀军[1] ZHOU Lili;WANG Guilong;GAO Hong;LIU Yanqiu;GUO Yaojun(Department of Anesthesiology, Donghua Hospital, Dongguan 523220, Guangdong, China;School of Anesthesia,Guizhou Medical University, Guiyang 550004, Guizhou, China;Department of Anesthesiology,the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China)

机构地区：[1]东莞东华医院麻醉科,广东东莞523220 [2]贵州医科大学麻醉学院,贵州贵阳550004 [3]贵州医科大学附院麻醉科,贵州贵阳550004

出　　处：《贵州医科大学学报》2019年第9期1097-1100,共4页Journal of Guizhou Medical University

基　　金：贵州省卫生计生委科学技术基金(gzwjkj2016-1-007)

摘　　要：目的:观察不同血浆靶控浓度瑞芬太尼致痛觉过敏的发生情况及其对血清中强啡肽表达水平的影响。方法:择期行妇科腹腔镜手术的患者60例,随机均分为对照组(C组)术中间断追加芬太尼1 μg/(kg·h)、小剂量瑞芬太尼组(S组,2 μg/L)、中剂量瑞芬太尼组(M组,4 μg/L )及大剂量瑞芬太尼组(L组,6 μg/L );于诱导前,术后苏醒即刻、苏醒后15 min、30 min、1 h、2 h、6 h、24 h 记录视觉模拟评分(VAS),记录各组患者痛觉过敏发生情况及术后哌替啶用量,用ELISA法检测诱导前、停药后7 min、苏醒后15 min、1 h测定血清强啡肽浓度。结果: M组、L组患者苏醒即刻、苏醒后15 min、30 min、1 h及2 h VAS评分明显高于C组、S组( P< 0.05);与C组比较,S组、M组与L组痛觉过敏发生率均明显增高( P< 0.05),哌替啶用量均明显增高( P< 0.05);与诱导前比较,M组、L组停药后7 min、苏醒后15 min及1 h血清强啡肽水平明显增加( P <0.05)。结论:大、中剂量瑞芬太尼可增加患者术后痛觉过敏的发生风险,其机制可能与强啡肽的表达增加有关。Objective: To observe the effects of different concentrations of remifentanil on hyperalgesia and serum dynorphin levels. Methods: Sixty female patients undergoing gynecologic laparoscopic surgery were randomly divided into four groups: control group (group C) with additional fentanyl 1 μg /(kg·h), low-dose remifentanil group (group S, 2 μg/L), medium dose remifentanil group (group M, 4 μg/L) and high dose remifentanil group (group L, 6 μg/L). VAS scores and hyperalgesia were recorded before induction, immediately after awakening, 15 min, 30 min, 1 h, 2 h, 6 h and 24 h after awakening. The dosages of pethidine were measured after the surgery. Serum dynorphin levels were assayed by ELISA at induction, at 7min after drug withdrawal, and at 15min and 1h after awakening. Results: The VAS scores of patients were significantly higher in groups M and L than those in groups C and S at immediately after awaking, at 15 minutes, 30 minutes, 1 h and 2 h after awaking ( P <0.05). The incidence rates of hyperalgesia and the dosages of meperidine in groups S, M and L were significantly increased ( P <0.05, P <0.05) relative to group C, respectively. Compared with before induction, serum dynorphin levels were significantly increased at 7 min after drug withdrawal, 15 min and 1 h after awaking in groups M and L( P <0.05). Conclusion: The large and medium dosages of remifentanil may increase the incidence rates of postoperative hyperalgesia in patients, and the mechanism may be related to the increased expression of dynorphin.

关 键 词：痛觉过敏 强啡肽 瑞芬太尼 麻醉 视觉模拟评分 腹腔镜 

分 类 号：R614.2[医药卫生—麻醉学]