艾司洛尔对雷米芬太尼诱导的术后痛觉过敏的影响

Effect of esmolol on remifentanil-induced hyperalgesia in patients undergoing laparoscopic cholecystectomy

目的探讨艾司洛尔对雷米芬太尼诱导的术后痛觉过敏的影响。方法 60例择期腹腔镜胆囊切除术患者随机均分为两组。麻醉诱导和维持采用丙泊酚、雷米芬太尼和七氟醚吸入。E组麻醉诱导同时静脉注射艾司洛尔0.3mg/kg,继之以30μg·kg-1·min-1持续泵注;C组以生理盐水作为对照。记录手术结束时及气管拔管即刻的平均动脉压和心率、术中雷米芬太尼用量和术后2、4、8、12和24h的视觉模拟评分(VAS),比较两组术后恶心、呕吐发生率。结果与C组比较,E组术中雷米芬太尼用量减少,术后VAS疼痛评分降低,术后恶心、呕吐发生率降低(P<0.05)。结论小剂量艾司洛尔能减轻雷米芬太尼诱导的术后痛觉过敏,并减少术后恶心、呕吐发生率。

Objective To investigate the effect of esmolol infusion on remifentanil-induced hyperalgesia in patients undergoing laparoscopic cholecystectomy （LC）. Methods Sixty patients scheduled for LC were equally assigned into two groups of E and C. General anesthesia with propofol, remifentanil and sevoflurane inhalation was performed. Esmolol 0. 3 mg/kg was intravenously injected before anesthesia induction in group E, which was followed by infusion in a dose of 30μg·kg^-1·min^-1 during operation. Group C received normal saline as the control. The mean arterial pressure and heart rate were recorded at the end of surgery and the time of extubation. The VAS pain scores were evaluated at 2, 4, 8, 12, and 24 h after operation. The incidence rate of postoperative nausea and vomiting were recorded as well. Results Compared to group C, the total consumption of remifentanil in group E was significantly less with reduced VAS pain scores at 2,4,8,12 and 24 h（P〈0. 05） and lower incidence rate of postoperative nausea and vomiting（P〈0. 05）. Conclusion Esmolol infusion in small dosage during remifentanil anesthesia can attenuate remifentanil-induced hyperalgesia and decrease the incidence rate of postoperative nausea and vomiting.