雷米芬太尼导致术后痛觉过敏的剂量依赖关系

目的 观察雷米芬太尼引起术后痛觉过敏的剂量依赖关系.方法 择期腹部手术患者300例随机均分成五组.各组维持麻醉的雷米芬太尼剂量分别为0.1μg·kg~(-1)·min~(-1)(R_(0.1)组),0.2 μg·kg~(-1)·min~(-1)(R_(0.2)组)、0.3μg·kg~(-1)·min~(-1)(R_(0.3)组)、0.4μg·kg~(-1)·min~(-1)(R_(0.4)组)、0.5μg·kg~(-1)·min~(-1)(R_(0.5)组).分别于术前(T_0)和静脉停止泵注雷米芬太尼后1 h(T_1)、1.5 h(T_2)、2 h(T_3)、3 h(T_4)、6 h(T_5)、12 h(T_6)、24 h(T_7)、48 h(T_8)应用机械压力法测定各组患者胫骨前皮肤的疼痛阈值,同时在T_1～T_8时记录患者VAS评分;记录患者术后镇痛药物的使用情况.结果 R_(0.3)、R_(0.4)、R_(0.5)组机械压力痛觉阈值T_1～T_5时较T_0时明显降低(P<0.05或P<0.01),R_(0.4)、R_(0.5)组T_6时仍然偏低(P<0.05).T_4～T_8时五组VAS评分均低于T_1时(P<0.05或P<0.01);T_1～T_6时R_(0.3)、R_(0.4)、R_(0.5)组VAS评分较R_(0.1)组明显升高(P<0.05或P<0.01),T_7时R_(0.4)、R_(0.5)组VAS评分仍然偏高(P<0.05或P<0.01).结论 雷米芬太尼剂量达到0.3μg·kg~(-1)·min~(-1)时可以降低患者机械压力痛觉阈值,并导致痛觉过敏.

The dose-dependent relationship of remifentanil inducing postoperative hyperalgia

Objective To observe the dose-dependent relationship remifentanil inducing postoperative hyperalgia. Methods Three hundred patients undergoing selective abdominal surgery under general anaesthesia were randomly divided into five groups with 60 cases each Anesthesia was maintained with isoflurane inhalaton, infusion of propofol 80μg·kg~(-1)·min~(-1),and remifentanil 0.1 (group R_0.1),0.2(group R_0.2),0.3(group R_0.3),0.4(group R_0.4),or 0.5μg·kg~(-1)·min~(-1)(group R_0.5).The pressure pain threshold(PPT)was evaluated before anesthesia(T_0)and 1 h(T_1),1.5 h (T_2),2 h(T_3),3 h(T_4),6 h(T_5),12 h(T_6),24 h(T_7),48 h(T_8)after stopping infusion of remifentanil. The VAS scoring was performed and the use of postoperative analgesic was recorded. Results Compared to T_0,the PPT was markedly decreased at T_1-T_5 in group R_(0.3) and at T_1-T_6 in group R_(0.4) and R_(0.5)(P<0.05).The VAS soores were increased significantly more in group R_(0.3) than those in group R_(0.1) at T_1-T_6 after stopping infusion of remifentanil (P<0.05 or P<0.01).The VAS scores was increased more significantly in group R_(0.4) and R_(0.5) than those in group R_(0.1) at T_1-T_7(P<0.05 or P<0.01).Conclusion The PPT was decreased significantly when the dosage of remifentanil infusion reached 0.3μg·kg~(-1) or more.