雷米芬太尼对丙泊酚靶控输注无痛人流术后宫缩痛的影响

Effect of remifentanil on the pain after artificial abortion under propofol infusion

目的探讨雷米芬太尼是否引起丙泊酚靶控输注(TCI)无痛人流术后宫缩痛的疼痛高敏以及阈下剂量氯胺酮是否对此有抑制作用。方法108例自愿接受静脉麻醉人工流产的孕妇随机分为四组:单纯丙泊酚(P)组,雷米芬太尼复合丙泊酚(R)组,氯胺酮复合丙泊酚(K)组,氯胺酮、雷米芬太尼复合丙泊酚(KR)组。记录术中孕妇体动次数和术后宫缩痛的VAS。结果每扩宫时R组HR、MAP较P组明显降低(P<0.05)。R组术后5minVAS和最高VAS明显高于其他三组(P<0.05)。术中四级体动P组和K组分别为4例和3例。结论丙泊酚用于无痛人流时,伍用雷米芬太尼可能引发疼痛高敏,加用阈下剂量的氯胺酮可减弱该现象。

Objective To investigate whether hyperalgesia would develop after artificial abortion anesthetized with propofol and remifentanil, and whether co-administration of ketamine would prevent that. Methods One hundred and eight early pregnant women undergoing artificial abortion under target controlled infusion（TCI） of propofol 7.5 μg/ml were randomized to 4 groups of propofol alone （group P）, remifentanil （0.6 μg/kg） （group R）, ketamine （0. 15 mg/kg） （group K）, and remifentanil plus ketamine （group KP）. VAS scoring was performed and body movement was recorded during operation. Results HR and MAP at uterine neck dilatation is lower in group R than that in group P（P〈0.05）. VAS score at 5 min during operation was significantly higher in group R than that in the other three groups （P〈0.05） . Body movement was seen in 4 cases of group P and in 3 cases of group KP. Conclusion Remifentanil （0. 6 bμg/kg） cotreated with propofol target concentration infusion increases the VAS score after artificial abortion, suggesting that remifentanil may induce opioid-induced hyperalgesia （OIH） and ketamine could probably prevent OIH.