尼古丁依赖程度对术后阿片类镇痛药需求量的影响

目的探讨尼古丁依赖程度对胸科手术后患者自控静脉镇痛（patient controlled intravenous analgesia，PCIA）阿片类药物需求量的影响。方法采用回顾性分析方法，纳入2012年2月～2013年8月实施PCIA的男性胸科手术患者215例，根据吸烟状况及尼古丁依赖Fagerstrom测试（fagerstrom test of nicotine dependence，VTND）评分分为非吸烟组（NS组，112例）、尼古丁中低度依赖组（MD组，58例）及尼古丁高度依赖组（HD组，45例）。通过术后镇痛数据库和Doeare手术麻醉系统提取患者的一般情况、吸烟状况、手术麻醉及术后镇痛等相关资料，进行统计分析。结果3组患者的一般资料、手术类型、术中芬太尼用量组间比较，差异无统计学意义（P〉0.05）；转入麻醉恢复室（postanesthesia care unit，PACU）及术后24、48h的疼痛评分组间比较，HD组和MD组高于NS组（P〈0.05），且HD组高于MD组（P〈0.05）；HD组术后24、48h累积舒芬太尼用量分别为（116±45）、（227±78）μg，MD组为（77±37）、（164±77）μg，两组均明显高于Ns组的（60±34）、（122±66）μg（P〈0.05）；且HD组亦高于MD组（P〈0.05）。FTND评分与术后24、48h舒芬太尼累积用量存在正相关关系（r分别为0370、0441，P〈0.001）。HD组术后恶心、呕吐的发生率分别为6.6％、2.2％，MD组为6.9％、3.4％，NS组为7.1％、3.6％，组间比较差异无统计学意义（P〉0.05）；3组均未发生呼吸抑制、过度镇静。结论吸烟者的术后疼痛程度和累积舒芬太尼用量高于非吸烟者，且随尼古丁依赖程度的升高，术后疼痛程度和累积舒芬太尼用量亦增加。

The effects of nicotine dependence on postoperative opioid requirements

Objective To investigate the effect of nicotine dependence on postoperative opioid requirement in patients undergoing thoracic surgery. Methods Two hundred and fifteen male patients （112 nonsmokers and 103 smokers） undergoing thoracic surgery were retrospectively analyzed. All patients received postoperative patient-controlled intravenous analgesia（PCIA） after surgery. Nicotine dependence was evaluated according to the Fagerstrom test of nicotine dependence（FTND ） questionnaires. Smokers were categorized into two groups： the low-dependent group（ MD group） with FTND scores 〈6（n=58 ） and high-dependent group （HD group） with FTND scores ≥ 6 （n=45）. Pain intensity was evaluated every 2 h after surgery, using the numerical rating scale （NRS）. The subtotal amount of sufentanil administered thru PCIA at 24 h and 48 h after surgery were recorded. Results There were no significant differences in baseline clinical characteristics and total fentanyl usage intraoperatively among the nonsmoker （NS）, MD, and HD groups. The NRS scores were significantly higher in the HD and MD groups compared with the NS group, and were higher in the HD group than in the MD group. The total dosage of sufentanil at 24 and 48 h after surgery in the HD group were （116±45）, （227±78） μg respectively, which were （77±37）, （164±77）μg in the MD group, and （60±34）, （122±66） μg in the NS group. The total dosage of sufentanil were higher in the HD and MD groups compared with the NS group （P〈0.05）, and were higher in the HD group than in the MD group （P〈0.05）. The FTND scores were positively correlated with the accumulated dosage of sufentanil in the 24 h（r=0.370 ） and 48 h（r=0.441 ） after surgery. The incidence of postoperative nausea and vomiting in the HD group were 6.6% and 2.2% respectively, which Were 6.9%, 3.4% in MD group, and 7.1% and 3.6% in the NS group. There were no significant difference among the three groups （P〉0.05）. None of all the patients