加巴喷丁预防病人开胸术后疼痛综合征的效果

Efficacy of gabapentin for prevention of post-thoracotomy pain syndrome

目的 探讨加巴喷丁预防病人开胸术后疼痛综合征的效果.方法 择期在全身麻醉联合硬膜外阻滞下行肺癌切除术的病人69例,年龄46 ～ 69岁,性别不限,体重47 ～ 78 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组：A组（n=36）和B组（n=33）.A组术前2h口服加巴喷丁300 mg,术后第1天开始口服加巴喷丁100 mg,3次/d,持续至术后第10天;B组服用安慰剂,方法同A组.2组麻醉诱导前行硬膜外镇痛,控制阻滞平面在T4.10水平.术后3d内行PCEA,维持VAS评分≤3分.记录术后6个月内疼痛的发生情况（数字分级法评分＞4分）和持续时间.记录术中丙泊酚、瑞芬太尼用量,术后PCEA按压次数;记录术后嗜睡、眩晕、乏力等不良反应的发生情况.结果 与B组比较,A组术后6个月内疼痛发生率降低,持续时间缩短（P＜0.05）,术中丙泊酚、瑞芬太尼用量、术后PCEA按压次数差异无统计学意义（P＞0.05）.B组未见不良反应发生;A组术后3d内有2例发生轻微头晕、乏力.结论 加巴喷丁（术前2h和术后10 d持续使用）可降低病人开胸术后疼痛综合征的发生,且无明显不良反应发生.

Objective To evaluate the efficacy of gabapentin for prevention of post-thoracotomy pain syndrome （PTPS）.Methods Sixty-nine ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 46-69 yr,weighing 47-78 kg,scheduled for elective resection for lung cancer under general anesthesia combined with epidural block,were randomly divided into 2 groups using a random number table：group A （n =36） and group B （n =33）.In group A,gabapentin 300 mg was given orally at 2 h before operation and gabapentin 100 mg was given orally three times a day from 1st day after operation until 10th day after operation.Group B received placebo instead of gabapentin.Epidural blockade with ropivacaine and sufentanil was performed before induction of anesthesia and the level of block was controlled at T4-10.Patient-controlled epidural analgesia （PCEA） was performed within 3 days after operation and VAS scores were maintained ≤ 3.The development of pain （numeric rating scale score 〉 4） within 6 months after operation and the duration were recorded.The consumption of propofol and remifentanil during operation and the number of attempts for PCEA after operation were recorded.The adverse reactions such as postoperative drowsiness,dizziness,fatigue were also recorded.Results Compared with B group,the incidence of pain within 6 months after operation was significantly decreased,the duration of pain was shortened （P 〈 0.05）,and no significant changes were found in the consumption of propofol and remifentanil during operation and the number of attempts for PCEA after operation in A group （P 〉 0.05）.No adverse reactions developed in group B.Mild dizziness and fatigue occurred in 2 patients in group A.Conclusion Gabapentin （continuous application at 2 h before operation and 10 days after operation） can reduce the development of PTPS in patients with no obvious adverse reactions.