术前应用加巴喷丁对瑞芬太尼致妇科腹腔镜患者术后痛觉过敏的影响

EFFECTS OF GAPAPENTIN ON REMIFENTANIL-INDUCED POSTOPERATIVE HYPERALGESIA AFTER GYNECOLOGICAL LAPAROSCOPY

目的探讨术前应用加巴喷丁对瑞芬太尼致术后痛觉过敏的影响。方法 60例择期妇科腹腔镜患者,ASA分级I～II级,年龄20～40岁,随机分为两组,每组30例:加巴喷丁组(G组)和对照组(C组)。G组在术前2 h口服加巴喷丁1 200 mg,C组术前2 h口服安慰剂。两组患者术中麻醉均靶控静脉泵注异丙酚和瑞芬太尼,并间断静脉注射顺阿曲库铵维持肌松。分别记录两组的麻醉时间、手术时间、恢复室观察时间;苏醒时间、意识恢复时间和拔管时间;术中的平均BIS值;Ramsay镇静评分;患者意识恢复时的视觉模拟评分(VAS);术中麻醉药物用量。两组术后均进行芬太尼静脉术后镇痛(PCIA),镇痛泵背景剂量均设置为空白,分别记录术后PCA泵中芬太尼用量,并记录术后并发症。结果①两组患者术中静脉麻醉药物用量(丙泊酚、瑞芬太尼)、苏醒时间、意识恢复时间、拔管时间比较均无明显差异(p>0.05);②G组的Ramsay镇静评分比C组明显降低(p<0.05),意识恢复时VAS评分比C组明显降低(p<0.05);③G组患者术后24 h内各时间点的PCA泵芬太尼用量比C组显著减少(p<0.05);④两组术后24 h的头痛、恶心、呕吐、寒战、瘙痒的发生率比较均无明显差异(p<0.05);G组躁动发生率比C组显著降低(p<0.05),但头晕发生率比C组显著增高(p<0.05)。结论术前应用加巴喷丁可有效抑制瑞芬太尼所致的术后痛觉过敏。

Objective To explore the effects of gapapentin on remifentanil-induced postoperative hyperalgesia after gynecological laparoscopy. Methods Sixty patients scheduled for laparoscopic cholecystectomy were randomly allocated to receive： ① Gapapentin 1 200 mg as premedication and intraoperative target-controlled infusion of remifentanil（Group P）;②a placebo as premedication and intraoperative target-controlled infusion of remifentanil（Group C）.Postoperative pain was controlled by Patient-controlled analgesia（PCA） with fentanyl.The patients were evaluated by using Visual analogue scale（VAS） for pain scores when they had recovered.The consumption of fentanyl,sedation score,and side effects were also observed. Results ①There were no significant difference in the consumption of propofol,remifentanil,emergence time,consciousness recovery time and extubation time（p0.05）.②Conpared with group C,the Ramsay sedation score,VAS of recovered time were significantly decreased in group P（p0.05）;③The fentanyl consumption in PCA were significantly at 1 h,2 h,4 h,8 h,12 h,24 h after operation in group P were less than those in group C（p0.05）;④The incidence of dizziness in group P was higher than group C（p0.05）,while the incidence of dysphoria was lower than group C（p0.05）. Conclusion Pretreatment with gapapentin can reduce remifentyl-induced postoperative hyperalgesia.