丙泊酚联合瑞芬太尼对非心脏手术患者疼痛敏感度的影响及机制研究

Impact of Propofol and Remifentanil on Pain Sensitivity in Patients with Non-cardiac Surgery and Study of the Mechanisms

目的研究丙泊酚联合瑞芬太尼对非心脏手术患者疼痛敏感度的影响及机制。方法选择2013年9月至2014年2月黄冈市黄州区人民医院收治的行全身麻醉非心脏手术患者160例,按照随机数字表法分为观察组(80例)和对照组(80例)。对两组患者使用微量泵输入剂量不同的瑞芬太尼和丙泊酚,观察组患者给予瑞芬太尼的剂量为0.8μg/(kg·min),对照组患者给予瑞芬太尼的剂量为0.4μg/(kg·min)。对患者的疼痛分级进行比较,治疗前后对患者进行视觉模拟评分(VAS),比较两组患者术后吗啡使用情况。结果术后,观察组患者的痛阈、耐痛阈均高于对照组[(2.1±0.4)m A比(1.7±0.3)m A,(3.8±1.0)m A比(3.2±1.0)m A],差异有统计学意义(P<0.01)。观察组疼痛程度轻于对照组,差异有统计学意义(P<0.05)。两组患者术后30 min、1 h、2 h、5 h、8 h VAS呈下降趋势,但术后2、5、8 h两组患者VAS评分无明显变化,两组间、不同时点间、组间·不同时点间交互作用比较差异有统计学意义(P<0.01)。观察组患者吗啡消耗量低于对照组[(0.40±0.01)mg比(1.31±0.37)mg],吗啡使用比例低于对照组[8.6%(7/80)比28.8%(23/80)],差异有统计学意义(P<0.01)。结论丙泊酚联合大剂量瑞芬太尼有利于缓解非心脏手术患者持久的疼痛敏感度,但是大剂量瑞芬太尼会诱导术后的痛觉过敏。

Objective To study the impact of different dosages of propofol and remifentanil on pain sensitivity in patients with non-cardiac surgery and the preliminary mechanisms. Methods Chosen from Sep.2013 to Feb. 2014 in Huangzhou People＇s Hospital 160 patients with non-cardiac surgery under general anesthesia were included in the study. According to the random number table method they were divided into observation group（ 80 cases） and control group（ 80 cases）. The two groups were given different dosages of remifentanil and propofol by micro-pump： the observation group was given a dose of remifentanil 0. 8 μg /（ kg·min）,the control group was given a dose of remifentanil 0. 4 μg/（ kg·min）. The patients＇ pain ratings were compared before and after treatment with visual analog scale（ VAS）,the postoperative morphine usage of the two groups was compared. Results After surgery,the pain threshold,resistance to pain threshold of the observation group was higher than the control group [（ 2. 1 ± 0. 4） m A vs（ 1. 7 ± 0. 3） m A,（ 3. 8 ± 1. 0） m A vs（ 3. 2 ± 1. 0） m A],the difference was statistically significant（ P〈0. 01）. The pain rating of the observation group was lighter than the control group,with statistical significance（ P〈0. 05）. Postoperative 30 min,1 h,2 h,5 h,8 h VAS of both groups were in down trend,though at 2,5,8 h VAS of the two groups had no significant changes,the differences between groups,time pints,groups·time points interaction were statistically significant（ P〈0. 01）. Morphine consumption in the observation group was significantly lower than the control group[（ 0. 40 ± 0. 01） mg vs（ 1. 31 ± 0. 37） mg],the number of people using morphine was significantly less than the control group[8. 6%（ 7 /80） vs 28. 8%（ 23 /80） ],the difference was statistically significant（ P〈0. 01）. Conclusion Propofol combined with high dose of remifentanil is helpful to ease the persistent pain sensitivity of patients with non-cardiac surgery,but large doses of remifentanil will induce postoperative hyperalgesia.