纳布啡联合帕瑞昔布预防术后瑞芬太尼诱导的痛觉过敏的研究  

Study of nalbuphine and parecoxib therapy attenuates remifentanil‑induced hyperalgesia after surgery

作　　者：刘越 武宙阳 邹家祺 练婉怡 徐世元[2] 雷洪伊 Liu Yue;Wu Zhouyang;Zou Jiaqi;Lian Wanyi;Xu Shiyuan;Lei Hongyi(Department of Anesthesiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Anesthesiology,Zhujiang Hospital of Southern Medical University,Guangzhou 510220,China;Department of Anesthesiology,Longgang Central Hospital of Shenzhen,Shenzhen 518116,China)

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉科,武汉430022 [2]南方医科大学珠江医院麻醉科,广州510220 [3]深圳市龙岗中心医院麻醉科,深圳518116

出　　处：《国际麻醉学与复苏杂志》2023年第4期360-365,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的观察纳布啡联合帕瑞昔布用于预防术后瑞芬太尼诱导的痛觉过敏(remifentanil⁃induced hyperalgesia,RIH)的效果。方法择期行腹腔镜子宫肌瘤切除术的患者96例,按随机数字表法分为4组:舒芬太尼组(S组,23例),麻醉诱导时给予舒芬太尼0.30μg/kg,术中间断追加舒芬太尼以维持全身麻醉;瑞芬太尼组(R组,25例),麻醉诱导时给予瑞芬太尼2.0μg/kg,术中持续泵注瑞芬太尼0.30μg∙kg−1∙min−1以维持全身麻醉;纳布啡+瑞芬太尼组(NR组,23例),麻醉诱导前15 min给予纳布啡0.1 mg/kg,诱导时给予瑞芬太尼2.0μg/kg,术中持续泵注瑞芬太尼0.30μg∙kg−1∙min−1以维持全身麻醉;纳布啡+帕瑞昔布+瑞芬太尼组(NPR组,25例),诱导前15 min给予纳布啡0.05 mg/kg、帕瑞昔布40 mg,麻醉诱导时给予瑞芬太尼2.0μg/kg,术中持续泵注瑞芬太尼0.30μg∙kg−1∙min−1以维持全身麻醉。术后均连接患者自控镇痛泵进行术后镇痛治疗。记录患者术后1、3、6、12、24、48 h时点数字分级评分法(Numerical Rating Scale,NRS)疼痛评分,术后3、6、12、24、48 h舒芬太尼累积消耗量,术后不良反应(寒战、恶心呕吐、嗜睡头晕、皮肤瘙痒)的发生情况。应用电子Von Frey刺激仪,测试患者术前及术后24 h前臂内侧及切口周围机械痛阈值。结果R组术后1、3、6、12、24 h NRS疼痛评分高于S组、NR组、NPR组(P<0.05),术后3、6、12、24、48 h舒芬太尼累积消耗量大于S组、NR组、NPR组(P<0.05),术后24 h切口周围及前臂内侧机械痛阈值低于S组、NR组、NPR组(P<0.05);NR组术后24 h切口周围及前臂内侧机械痛阈值低于NPR组(P<0.05)。4组患者术后寒战、恶心呕吐、嗜睡头晕及皮肤瘙痒发生率差异无统计学意义(P>0.05)。结论纳布啡联合帕瑞昔布可以有效预防术后RIH。Objective To observe the effect of nalbuphine and parecoxib therapy attenuates remifentanil⁃induced hyperalge⁃sia(RIH)after surgery.Methods A total of 100 patients who were scheduled for laparoscopic hysterectomy were selected.According to the random number table method,they were divided into four groups:a sufentanil group(group S,n=23),which was administered with 0.30μg/kg sufentanil during anesthesia induction followed by intermittent addition of sufentanil during surgery for anesthesia maintenance;a remifentanil group(group R,n=25),which received remifentanil at 2.0μg/kg during anesthesia induction followed by continuous infusion of remifentanil at 0.30μg∙kg−1∙min−1 for anesthesia maintenance during surgery;a nalbuphine+remifentanil group(group NR,n=23),which was administered with 0.1 mg/kg nalbuphine 15 min before anesthesia induction,then received 2.0μg/kg remifentanil during anesthesia induction,before continuous infusion of remifentanil at 0.30μg∙kg−1∙min−1 for anesthesia maintenance during surgery;and a nalbuphine+parecoxib+remifentanil group(group NPR,n=25),which received 0.05 mg/kg nalbuphine and 40 mg parecoxib 15 min before anesthesia induction,then received 2.0μg/kg remifentanil during anesthesia induction,before continuous infusion of remifentanil at 0.30μg∙kg−1∙min−1 for anesthesia maintenance during surgery.All patients received patient⁃controlled analgesia pump for postoperative analgesia.The Numerical Rating Scale(NRS)scores at postoperative 1,3,6,12,24,and 48 h,the consumption of sufentanil at postoperative 3,6,12,24,and 48 h,and the incidence of major adverse reactions such as shivering,nausea and vomiting,drowsiness and dizziness,and skin itching after surgery were recorded.The mechanical pain threshold of the inner forearm and incision side was tested using an electronic Von Frey stimulator before surgery and 24 h after surgery.Results Compared with groups S,NR,and NPR,group R showed increases in NRS scores at postoperative 1,3,6,12,and 24 h(P<0.05),incre

关 键 词：腹腔镜子宫肌瘤切除术 纳布啡 帕瑞昔布 瑞芬太尼 痛觉过敏 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]