瑞芬太尼诱发痛觉过敏的定量感觉测定及右美托咪定的预防作用

Quantitative sensory testing of remifentanil-induced hyperalgesia and the preventive effect of dexmedetomidine

目的定量测定术中持续静注瑞芬太尼诱发的痛觉过敏,观察右美托咪定术前应用对瑞芬太尼诱发痛觉过敏的预防作用。方法选择ASAⅠ～Ⅱ级择期行瑞芬太尼麻醉下腹腔镜胆囊切除术患者40例,随机分为观察组(术前应用小剂量右美托咪定)和对照组。Von Frey纤毛法测定两组患者手术前后皮肤痛阈值的变化,记录术后24 h内镇痛药的使用情况。结果观察组拔管后30 min、1 h痛阈下降发生率明显低于对照组,且术后24 h内要求镇痛的例数少于对照组。结论采用Von Frey纤毛定量测定皮肤痛阈值可为术后痛觉过敏的发生提供客观依据;右美托咪定可降低瑞芬太尼麻醉后早期痛觉过敏的发生率,减少术后镇痛药的使用。

Objective To determine quantitatively hyperalgesia induced by a larger dose of remifentanil and investigate the preemptive analgesia of small dose dexmedetomidine on remifentanil-induced hyperalgesia.Methods Forty ASAⅠ or Ⅱ adult patients who underwent laparoscopic cholecystectomy were randomized into experimental group and control group,20 cases in each group.The changes of the pain-threshold of the skin and analgesia in 24 h after operation were recorded.Results The pain-threshold at the time of 30 min and 1h after extubation decreased significantly in experimental group,and the number of analgesia needed in 24 h after operation was less in experimental group.Conclusion There is a more objective basis for the occurrence of hyperalgesia with the quantitative determination of pain-threshold at the same site of skin by Von Frey fibers.The preemptive analgesia of small dose dexmedetomidine could decrease the incidence of remifentanil-induced hyperalgesia and reduce the analgesia dosage after the operation.