新疆维吾尔族与哈萨克族和汉族患者疼痛敏感性及舒芬太尼镇痛剂量的比较研究

Pain Sensitivity and Sufentanil Dose for Analgesia Among Patients of Uyghur,Kazak and Han Gthnic Groups in Xinjiang Uygur Automonous Region

目的探讨新疆维吾尔族、哈萨克族及汉族在试验性疼痛、术后疼痛及术后阿片类药物用量的差异。方法前瞻性选取2013年8月—2014年10月于新疆医科大学附属中医医院行结直肠癌根治术的患者93例为研究对象,其中维吾尔族32例,哈萨克族31例,汉族30例。采用便携式压力测试仪,于患者右前臂内侧腕横纹上2 cm处测定压力痛域(PPT)和压力耐痛域(PTO)。患者术后48 h内均使用静脉病人自控镇痛(PCA),分别于术后6、12、24、48 h进行疼痛视觉模拟评分(VAS)。如果患者在上述任意时间点出现VAS>4分,即定义为存在镇痛不全,立刻静脉给予帕瑞昔布钠40 mg。记录不良反应(如恶心、呕吐、瘙痒和呼吸抑制)的发生情况及镇痛结束后PCA泵中舒芬太尼的用量。结果维吾尔族、哈萨克族及汉族患者PPT比较,差异无统计学意义(P>0.05)。3个民族PTO比较,差异有统计学意义(P<0.05);其中,哈萨克族和汉族患者PTO高于维吾尔族,差异有统计学意义(P<0.05)。民族和术后时间对VAS的影响无交互作用(P>0.05),但不同民族间VAS比较,差异有统计学意义(P<0.05);其中哈萨克族、汉族患者术后6 h VAS低于维吾尔族,差异有统计学意义(P<0.05)。不同民族舒芬太尼用量及镇痛不全比例比较,差异均有统计学意义(P<0.05);其中哈萨克族、汉族患者舒芬太尼用量及镇痛不全比例低于维吾尔族,差异有统计学意义(P<0.05)。维吾尔族、哈萨克族和汉族分别有7例(21.9%)、6例(19.4%)、6例(20.0%)发生呕吐,各民族呕吐发生率比较,差异无统计学意义(χ2=0.07,P=0.96)。维吾尔族、哈萨克族及汉族患者PTO与术后6、12 h VAS均呈负相关(P<0.05),各民族患者PPT、PTO与舒芬太尼用量均无直线相关(P>0.05)。结论维吾尔族在试验性疼痛、术后疼痛及术后阿片类药物用量方面与哈萨克族和汉族均存在差异,术前PTO可能有助于预测术后疼痛严重程度。

Objective To explore the differences in experimental pain,postoperative pain and postoperative opioid dosage among Uygur, Hazak and Han ethnic groups in Xinjiang Uygur Automonous Region. Methods In this prospective study,we enrolled 93 patients who underwent radical resection of rectal carcinoma from August 2013 to October 2014,among which 32 patients were Uyghur people,31 patients were Kazak people and 30 patients were Han people. Pressure pain threshold（ PPT） and pressure pain tolerance（ PTO） were measured before surgery by portable pressure tester 2 cm above the horizontal stripes on the inner side of the wrist of the right arms of the patients. Intravenous patient controlled analgesia（ PCA） was performed within 48 hours after surgery. Visual analogue scale（ VAS） scores were recorded 6 h,12 h,24 h and 48 h after surgery. VAS score 4 was recorded as inadequate analgesia, and 40 mg parecoxib was given by intravenous vein immediately. The occurrence of adverse reactions（ nausea, vomit, pruritus and respiratory depression） and the dosage of sufentanil in PCA pump when analgesia ended were recorded. Results There was no statistically significant differences in PPT among the three ethnic groups（ P〈0. 05）. Significant differences existed in PTO among the three ethnic groups（ P〈0. 05）;Kazak patients and Han patients were higher than Uygur patients in PTO（ P〈0. 05）. There was no interaction between ethnic group and postoperative time（ P〈0. 05）; and there was statistically significant difference on VAS score among three groups（ P〈0. 05）; Kazak patients and Han patients were lower than Uygur patients in VAS score 6 hours after operation（ P〈0. 05）.Different ethnic groups were significantly different in the dosage of sufentanil and the proportion of incomplete analgesia（ P〈0. 05）; Kazak patients and Han patients were lower than Uygur patients in the dosage of sufentanil and the proportion of incomplete analgesia（ P〈0. 05）. Vomit occurred in 7（ 21. 9%） Uygur patients, 6（ 19. 4%） Kazak patients and 6（ 20. 0%） Han patients,with no significant differences among them（ χ2= 0. 07,P = 0. 96）. PTO of the three ethnic groups was negatively correlative with VAS score 6 hours and 12 hours after operation（ P〈0. 05）,while PPT and PTO had no linear correlation with the dosage of sufentanil（ P〈0. 05）. Conclusion Differences exist in experimental pain,postoperative pain and postoperative opioid dosage between Uygur patients and Kazak and Han patients. Preoperative PTO may help to predict postoperative pain severity.