不同麻醉药对瑞芬太尼诱发术后痛觉超敏的影响

The Effect of Different Anesthetics on Remifentanil-induced Postoperative Hyperalgesia

目的:评价不同麻醉药对瑞芬太尼诱发术后痛觉超敏的影响。方法:40只尾静脉置管成功的成年雄性SD大鼠,根据不同麻醉方式随机分为5组(n=8):七氟醚麻醉组(S组);七氟醚+瑞芬太尼复合麻醉组(S+R组);小剂量丙泊酚麻醉组(Pro组);小剂量丙泊酚+瑞芬太尼麻醉组(Pro+R组);大剂量丙泊酚+瑞芬太尼麻醉组(HPro+R组)。在不同麻醉方式下建立大鼠后足切割痛模型并维持麻醉一小时,于术前24小时以及停药后6小时,24小时,48小时测定双后足的机械痛阈(PWT)及观测以上不同时间点切割足的累积疼痛评分(CPS)。结果:S+R组与S组相比,停药后6小时切割足的CPS增加(P<0.05)、24小时双后足的PWT均下降(P<0.05)。HPro+R在停药后各时间点切割足的PWT均高于Pro组(P<0.001)、Pro+R组(P<0.01)。与Pro+R组相比,HPro+R组在停药后各时间点切割足的CPS均低于Pro+R组(P<0.05)。结论:吸入麻醉药七氟醚可加剧瑞芬太尼导致的术后痛觉过敏,而大剂量丙泊酚可抑制瑞芬太尼诱发的术后痛觉过敏。

Objective： To assess the effect of different anesthetics（sevoflurane, propofol） on remifentanil-induced postoperative hyperalgesia. Methods： Forty male adult Sprague-Dawley rats in which caudal vein catheter was successfully placed were randomly divided into 5 groups（n=8）： sevoflurane anesthesia group（Group S）, sevoflurane ＋remifentanil anesthesia group（Group S＋R）, low dose of propofol anesthesia group（Group Pro）, low dose of propofol＋remifentanil anesthesia group（Group Pro＋R）, high dose of propofol＋remifentanil anesthesia group（Group HPro＋R）. All the rats underwent plantar incision under anesthesia with the different anesthetic ways, respectively. Paw withdrawal threshold（PWT） and cumulative pain score（CPS） were measured at 24 h before anesthesia and 6 h,24 h, 48 h after anesthesia. Results： Compared with group S, the CPS in the group S＋R was significantly increased（P〈0.05） at 6 h post-anesthesia; the PWT of bilateral hind paws of rats in the group S＋R were significantly decreased（P〈0.05） at 24 h post-anesthesia.The PWT of the incision paw of rats in the group HPro＋R was significantly increased（P〈0.05） as compared with that of the group Pro and group Pro＋R at 6 h, 24 h, 48 h post-anesthesia. In addition, the CPS of the incision paw in group HPro＋R was significantly lower than that of group Pro＋R（P〈0.05） at 6 h, 24 h, 48 h post-anesthesia. Conclusions： Sevoflurane could exacerbate the remifentanil-induced postoperative hyperalgesia in rats, whole high dose of propofol could prevent it.