高乌甲素对瑞芬太尼持续输注所致术后疼痛及痛觉过敏的影响

Effects of lappaconitine on intraoperative administration of remifentanil induced postoperative hyperalgesia in general anaesthesia patients

目的观察高乌甲素对瑞芬太尼持续输注所致术后痛觉过敏的影响。方法选择2016年3至10月宁波市第二医院接受择期甲状腺手术患者120例。年龄20～60岁，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级。采用随机数字表法将患者分为3组（n=40）：S组（小剂量瑞芬太尼组，0．1μg·kg-1·min-1），L组（大剂量瑞芬太尼组，0．3μg·kg·min-1），G组（高乌甲素＋大剂量瑞芬太尼组，0．3μg·kg-1·min-1），手术结束前30min给予G组患者静脉注射8mg高乌甲素。记录术后2、6、24h时的机械痛阈值、疼痛视觉模拟评分（VAS）和镇痛药物消耗量。结果3组患者术后2、6、24hVAS评分和吗啡累积消耗量差异均无统计学意义（均P〉0．05）；3组患者术前和术后2h的机械痛阈值差异均无统计学意义（均P〉0．05）。S组、L组和G组术后6h机械痛阈值分别为（45．7±15．6）、（35．8±15．0）、（47．6±16．4）g，术后24h分别为（50．7±17．0）、（33．7±14．0）、（49．7±13．9）g，差异均有统计学意义（F=6．586、16．089，均P〈0．01）。与S组比较，L组患者术后6、24h的机械痛阈值显著降低（q=2．837、5．045，均P〈0．01），而G组患者术后6、24h的机械痛阈值明显高于L组（q=3．384、4．770，均p〈0．01）。结论高乌甲素能够缓解大剂量瑞芬太尼持续输注所致的术后痛觉过敏。

Objective To explore the effects of lappaconitine on intraoperative administration of remifentanil induced postoperative hyperalgesia in general anaesthesia patients. Methods One hundred and twenty patients from March to October 2016 undergoing elective thyroid operation under general anaesthesia at Ningbo NO. 2 hospital, American Society of Anesthesiologists（ASA） Ⅰ or Ⅱgrade, aged 20 -60, were enrolled in this study and randomly assigned to 3 groups （ n = 40 ）. Remifentanil was intraoperatively infused at 0. 1 μg · kg-1 · min -1 （ Group S） or 0. 3 μg · kg-1 · min-1 （ Groups L and G） , and patients in group G received lappaconitine 8 mg 30 minutes before the ending of surgery. Mechanical pain thresholds, visual analogue scale （VAS） and additional analgesics were recorded at 2, 6 and 24 hours after the operation. Results There was no significant difference among the VAS and additional analgesics in three groups at 2, 6 and 24 h after operation （ all P 〉 0. 05 ）. There was no significant difference among the mechanical pain thresholds in three groups before and 2 h after operation （ all P 〉 0. 05 ）. The mechanical pain thresholds of group S, L and G was （45.7 ± 15.6）, （35. 8 ±15.0）, （47. 6 ± 16.4）g at 6 h and （50. 7 ±17.0）, （33.7 ± 14. 0 ） , （49.7 ± 13.9 ）g at 24 h after operation. There was significant difference among the mechanical pain thresholds in groupS, L and G at 6 h and 24 h after operation （F=6.586, 16. 089, all P〈0.01）. Compared to group S, the mechanical pain thresholds significantly decreased in group L at 6 h and 24 h after operation （ q = 2. 837, 5. 045, all P 〈 0. 01 ）. While there was a significantly increase in pain thresholds at 6 h and 24 h postoperatively in group G, as compared with the group L （q = 3. 384, 4. 770,all P 〈 0. 01 ）. Conclusion Lappaconitine significantly alleviated intraoperative administration of remifentanil induced postoperative hyperalgesia in general anaesthesia patients.