雷米芬太尼的剂量对其诱发术后痛觉过敏作用的影响

Effect of dosage of remifentanil on remifentanil-induced hyperalgesia

目的探讨不同剂量雷米芬太尼对其诱发痛觉过敏的影响。方法择期腹腔镜胆囊切除术患者80例随机均分为A、B、C、D四组,麻醉分别用雷米芬太尼0.1、0.2、0.4μg.kg-1.min-1静脉微量泵注及芬太尼分次静脉注射维持。术后四组均用芬太尼进行患者自控镇痛(PCA)。记录术后苏醒即刻(T1)、苏醒后30min(T2)、60min(T3)时的Ramsay镇静评分(RS)和T1、T2、T3、苏醒后2h(T4)、4h(T5)、8h(T6)、24h(T7)时的VAS疼痛评分;记录苏醒后24h内芬太尼消耗总量和PCA泵按压次数。结果 C组术后RS评分均高于其他三组,VAS评分在T1,T2时均高于其他三组;B、C组VAS评分在T5时高于A、D组,B组VAS评分在T6时高于其他三组(P<0.05)。C组术后24h芬太尼消耗总量大于A组,PCA泵按压次数多于其他三组(P<0.05)。结论雷米芬太尼静脉麻醉会导致剂量相关性的术后痛觉过敏。

Objective To investigate the effects of different doses of remifentanil on hyperalgesia induced by remifentanil use. Methods Eighty patients underwent laparoscopic cholecyst- ectomy were anesthetized with total intravenous anesthesia of remifentanil 0. 1 μg . kg-1. min-1 （group A,20 cases）, remifentanil 0. 2μg . kg-1 min-1 （group B, 20 cases）, remifentanil 0. 4 μg . kg-1 .min-1 （group C, 20 cases） or fentanyl（group D, 20 cases as control）. After the patients were fully recovered from anesthesia,the postoperative patient controlled analgesia（PCA） with fentanyl was used in all cases. Ramsay score at the time of regaining consciousness （T1） and 30 min （T2）, 60 min （T3） thereafter and visual analogue scale（VAS） pain score at T1, T2, T3 and 2 h（T4）, 4 h（T5）, 8 h（T6） and 24 h（T7） after operation were obtained in 4 groups. Fentanyl consumption and PCA number were recorded within 24 hours after surgery. Results Compared with other three groups,Ramsay score was significantly higher at T1-T3 and VAS score was significantly higher at T1, T2 in group C. VAS scores in groups of B and C were significantly higher than those in groups of A and D at T5, which in group B were significantly higher than those in the other three groups at T6 （P〈0. 05）. Fentanyl consumption in group C was more than that in group A and PCA number in group C was higher than those in the other three groups（P〈0. 05）. Conclusion Remifentanil may dose-dependently induce a hyperalgesia after its withdrawal.