硫酸镁预防瑞芬太尼术后痛觉过敏

目的观察术中静脉注射硫酸镁预防瑞芬太尼麻醉患者术后痛觉过敏的效果。方法择期行腹腔镜胆囊切除术患者60例,随机分为硫酸镁治疗组（M组,n=30）和对照组（C组,n=30）。常规诱导插管后,以0.4μg·kg-1.min-1速率维持瑞芬太尼输注,调节七氟醚吸入浓度维持BIS至40~60之间。M组麻醉诱导后15 min内静脉注射硫酸镁50 mg/kg后以15 mg·kg-1.h-1速率维持输注至手术结束;C组输注等质量生理盐水。记录术后30 min、1 h、2 h、4 h、8 h、12 h、24 h VAS评分,测定患者术前1 d及术后2 h、24 h静脉血Mg2＋浓度;手术前1 d及术后24 h进行2 min步行测验（2MWT）。观察并记录患者恶心呕吐、镇静、低血压等不良反应发生率。结果与C组比较,M组患者术后2 h及以内VAS评分有统计学差异（P〈0.05）,术后4~24 hVAS评分差异无统计学意义（P〉0.05）。术后2 h,M组血浆中Mg2＋浓度较C组显著增加（P〈0.05）,术后24 h恢复正常。M组患者术后24 h 2MWT距离恢复较C组快（P〈0.05）,M组患者恶心呕吐发生率较C组显著降低（P〈0.05）。结论术中静脉注射硫酸镁可有效预防瑞芬太尼术后痛觉过敏,促进患者术后功能恢复且不增加不良反应。

Modulation of Remifentanil induced hyperalgesia by magnesium sulfate

Objective To observe the preventative effects of intravenous injection of magnesium sulfate during operative time on Remifentanil-induced hypersensitivity.Methods Sixty adults undergoing selective laparoscopic cholecystectomy were randomly divided into magnesium sulfate treatment group（group M,n=30） and control group（group C,n=30）.After conventional intubation,Remifentanil was infused at a rate of 0.4 μg·kg-1·min-1 and the concentration of sevoflurane was regulated to maintain the BIS within 40~60.Group M received 50 mg/kg MgSO4 by intravenous injection within 15 min after anesthesia induction then the infusion was maintained at a rate of 15 mg·kg-1·h-1 until the end of operation.Group C received the same volume of isotonic saline over the same period.Visual analogue scores（VAS） at 30 min,1 h,2 h,4 h,8 h,12 h,24 h postoperatively were recorded.Postoperative serum Mg2＋ concentration was monitored 1day before,2h and 24h after the operation.2 minutes walking tests（2MWT） was assessed 1 day before and 24 h after the operation.Side effects such as vomit,nausea,sedation and hypotension were recorded.Results The VAS within 2 h were statistically different between the two groups（P0.05）,however,there was no statistic significance in VAS within 4~24 h postoperatively（P0.05）.The concentrations of Mg2＋ in group M were significantly increased at 2 h after the operation compared with those in group C（P0.05） and were returned to normal at 24h post the operation.The patients in group M had quicker recovery at 24h after the operation than the patients in group C（P0.05）.The incidences of vomit,nausea were lowered in group M than those in group C（P0.05）.Conclusion Intravenous injection of MgSO4 during operation is effective in preventing postoperative hyperalgesia induced by Remifentanil and it can promote the functional recovery of patients without increasing adverse events.