月经周期对患者痛阈及芬太尼镇痛效应的影响

Influence of menstrual cycle on pain threshold and analgesic effect of fentanyl in women undergoing laparoscopic surgery

目的观察不同月经周期(卵泡期和黄体期)是否影响妇科腹腔镜手术患者的痛阈和耐痛阈,探讨月经周期和术中芬太尼用药量之间的关系。方法择期行腹腔镜子宫全部切除手术患者40例,根据血清孕酮浓度分为卵泡期组(F组,血清孕酮浓度0.3~1.5ng/ml)和黄体期组(L组,血清孕酮浓度5.5~17.8ng/ml),每组20例。患者于术前0.5h采用痛阈测定仪测定患者的痛阈及耐痛阈,术后72h(撤除镇痛泵后24h)再次测量并记录患者的痛阈和耐痛阈。结果 L组患者术前痛阈、耐痛阈及术后72h的痛阈、耐痛阈均显著高于F组(P<0.05),且F组患者痛阈与术前孕酮浓度之间呈正相关(r=0.489,P<0.05);L组患者痛阈与术前孕酮浓度之间亦呈正相关(r=0.814,P<0.01);两组患者术中、术后镇痛泵芬太尼用量比较差异无统计学意义。结论月经周期可明显影响女性患者的痛阈和耐痛阈,孕酮浓度与痛阈有明显的相关性,但对术中芬太尼的需求量没有明显影响。

Objective To investigate the effect of menstrual cycle on the pain threshold and pain tolerance threshold in women undergoing laparoscopic surgery.Methods Forty ASA Ⅰ or Ⅱ female patients aged 41 ～ 49 years scheduled for elective laparoscopic hysterectomy were divided into follicular phase group （group F,n=20） and luteal phase group （group L,n=20） according to serum progesterone levels （0.3-1.5 ng/ml and 5.5-17.8 ng/ml,respectively）.The pain threshold and pain tolerance threshold were measured by pain threshold detector 0.5h before operation.Postoperative intravenous analgesia pump was applied.The pain threshold and pain tolerance threshold were measured again at 72h after surgery.Results The preoperative and 72h-postoperative pain threshold and pain tolerance threshold in group L were significantly higher than those in group F （P〈0.05）.The pain threshold was positively correlated with progesterone concentrations before surgery in group F （r=0.489,P=0.029） and in group L（r=0.814,P =0.000）.There was no significantly difference in intraoperative fentanyl consumption between two groups （P 〉0.05）.Conclusion Menstrual cycle can significantly affect the pain threshold and pain tolerance threshold in female patients undergoing laparoscopic surgery,which are positively correlated with progesterone concentrations.But the menstrual cycle seems to have no significantly affect on intraoperative fentanyl consumption.