丙泊酚抑制高剂量瑞芬太尼诱发痛觉过敏的临床观察

Modulation of high dose remifentanil induced hyperalgesia by propofol in humans

目的 观察丙泊酚-瑞芬太尼麻醉对不同剂量瑞芬太尼诱发术后痛觉过敏的影响。方法 选择90例年龄在20~60岁、ASAⅠ-Ⅱ级的腹腔镜胆囊切除手术（LC）患者,随机分为七氟烷和低剂量瑞芬太尼组（SL组）、七氟烷和高剂量瑞芬太尼组（SH组）、以及丙泊酚和高剂量瑞芬太尼组（PH组）,每组30例。SL组和SH组均以七氟烷复合瑞芬太尼诱导;PH组以丙泊酚复合瑞芬太尼诱导。麻醉维持：SL组为七氟烷和瑞芬太尼[0.1μg/（kg·min）],SH组为七氟烷和瑞芬太尼[0.3μg/（kg·min）],PH组为丙泊酚和瑞芬太尼[0.3μg/（kg·min）]。分别在术前、术后6h和24h测量切口周围（脐周）的机械痛阈,记录术后舒芬太尼消耗量、视觉模拟评分（VAS）和相关不良反应。结果 与SL组比较,SH组患者的术后6h、24h的脐周机械痛阈明显降低（P〈0.05）,术后30min、2h及6h的VAS评分明显增高（P〈0.05）;与SH组比较,PH组患者的术后6h、24h的脐周机械痛阈值明显增高（P〈0.05）,术后30min、2h及6h切口疼痛程度明显降低（P〈0.05）。PH组和SL组患者舒芬太尼消耗总量明显低于SH组（P〈0.05）。结论 丙泊酚复合瑞芬太尼静脉麻醉可减轻因高剂量瑞芬太尼诱发的术后痛觉过敏。

Objective To investigate the effects of maintenance or sevoflurane on postoperative hyperalgesia by different dosage of remifentanil- based anaesthesia. Methods Ninety patients aged 20-60 years old with an ASA physical status of Ⅰ or Ⅱ undergoing laparoscopic cholecystectomy were randomly assigned into three groups： sevoflurane with low dose remifentanil group （SL group）, sevoflurane with high dose remifentanil group （SH group） and propofol with high dose of remifentanil group （PH group）. The patients in SL group and SH group were induced with sevoflurane and remifentanil patients in PH group were induced with propofol and remifentanil. Anaesthesia was maintained according to the allocated group, SL group with sevofturane and remifentanil 0.1 μg/ （kg ·min）, SH group with sevoflurane and remifentanil 0.3μg/ （kg·min）, PH group with propofot and remientanil 0.3 μg/ （kg·min）. The mechanical pain threshold on the incision site was measured in the preoperative and postoperative 6 h and postoperative 24 h, respectively. The postoperative analgesic consumption, visual analogue scale （VAS） score, and incidence of related side effects also recorded. Results Mechanical pain threshold at the incision site was significantly lower at 6 hours and 24 hours postoperative time points and the VAS scores at postoperative 30 rain, 2hours, 6 hours were high-er in SH group when compared with SL group; the mechanical pain threshold at the incision site was significantly higher at 6 hours and 24 hours postoperative time points and the VAS scores at postoperative 30 min, 2 hours, 6 hours were lower in PH group when compared with SH group （all P〈0.05） ; the total amounts of sufentanil consumption were significantly higher in SH group at postoperative 24 h than those in other two groups （all P〈0.05）. Conclusion The maintenance of general anaesthesia by propofol may reduce remifentanil-induced hyperalgesia induced by high dose of remifentanil usage.