羟考酮预防瑞芬太尼诱发痛觉敏化的临床效果

Preventive effects of oxycodone on remifentanil-induced hyperalgesia in clinical

目的:观察羟考酮对瑞芬太尼诱发痛觉敏化的预防作用。方法:选择择期行腹腔镜单侧卵巢囊肿剥除术的患者40例,年龄18~59岁,ASAⅠ~Ⅱ级,随机分为对照组(C组,n=15)和羟考酮组(O组,n=25),共40例。患者入室后应用Von Frey纤毛法测定基础机械性疼痛阈值,麻醉诱导依次静脉注射咪达唑仑0.04 mg·kg^-1、依托咪酯0.2 mg·kg^-1、顺式阿曲库铵0.2 mg·kg^-1、瑞芬太尼1μg·kg^-1后,置入4号LMA喉罩后接麻醉机行机械通气。所有患者均为全凭静脉维持麻醉,输注丙泊酚4~6 mg·kg^-1·h^-1,维持BIS值40~60,瑞芬太尼以0.2μg·kg-^1·min-1的恒速泵注。切皮前5 min,O组静脉给予羟考酮,C组给予等量生理盐水。羟考酮的初始剂量为0.1 mg·kg^-1。根据患者机械性痛阈的变化,并运用"序贯法"调整给药剂量,剂量调整间隔0.02 mg·kg^-1。根据Probit分析,计算羟考酮预防瑞芬太尼导致的痛觉敏化的半数有效剂量(ED50)和95%有效剂量(ED95)。记录拔喉罩后VAS评分,以及寒战、恶心、呕吐等并发症。结果:C组应用瑞芬太尼后术后机械性疼痛阈值4 g明显低于术前机械性疼痛阈值15 g。O组术后机械性疼痛阈值与术前相比差异无统计学意义。O组术后VAS评分明显低于对照组术后(P<0.05)。羟考酮预防瑞芬太尼导致的痛觉敏化的ED50为0.058(95%CI=0.040~0.076)mg·kg^-1,ED95为0.090(95%CI=0.074~0.212)mg·kg^-1。两组术中应用血管活性药、术后寒战、恶心呕吐的发生率无统计学差异。结论:术前应用羟考酮能够有效预防瑞芬太尼导致的痛觉敏化。

Objective:To observe the preventive effects of oxycodone on remifentanil-induced hyperalgesia.Methods:Forty patients(18 to 59 years old,ASAⅠ~Ⅱ)undergoing laparoscopic unilateral cyst of ovarian removal surgery were randomly divided into two groups:oxycodone group(group O,n=25)and control group(group C,n=15).After entering the operation room,the skin pain-threshold of all the patients was measured by Von Frey Hairs.Anesthesia was induced by midazolam 0.04 mg·kg^-1,remifentanil 1μg·kg^-1(injected for more than 1 min),etomidate 0.2 mg·kg-1,and cisatracurium 0.2 mg·kg-1.Then the patients were ventilated by 4#LMA laryngeal masks.Anaesthesia was maintained with infusion of remifentanil(0.2μg·kg^-1·min-1)and propofol(4~6 mg·kg^-1·h^-1).BIS value was maintained 40~60 by adjusting the dose of propofol.Five minutes before skin incision,patients in Group O were given oxycodone intravenously,and an equal volume of normal saline was given to the patients in group C.The first patient received 0.1 mg·kg^-1 oxycodone,and adjusted the dose according to the change of skin pain-threshold of the patient using sequential method.The dose adjustment space was 0.02 mg·kg^-1.The ED50,ED95 and 95%confidence interval(CI)of oxycodone for prevention of remifentanil-induced hyperalgesia were obtained by probit analysis.VAS at 15 min after tracheal extubation,postoperative nausea and vomiting and shivering were recorded.Results:The skin pain-thresholds of Group C were lower after remifentanil anesthesia than before.Injecting oxycodone before surgery prevented remifentanil-induced hyperalgesia.The VAS scores at 15 min after tracheal extubation were significantly lower in group O than in group C.The ED50 and ED95 of oxycodone for prevention of remifentanil-induced hyperalgesia were 0.058 and 0.090 mg·kg^-1,respectively.The incidences of adverse effects and the number of vasoactive drugs needed were similar in both groups.Conclusion:Oxycodone can prevent remifentanil-induced hyperalgesia in patients undergoing laparoscopic unilateral cyst of ovarian removal surgery.