芬太尼诱发腹腔镜胆囊切除术患者术后痛觉过敏的剂量效应关系

Dose-effect relation of fentanyl on postoperative hyperalgesia in patients undergoing laparoscopic cholecystectomy

目的观察芬太尼诱发腹腔镜胆囊切除术患者术后痛觉过敏的剂量效应关系。方法择期行腹腔镜胆囊切除术男性患者100例,年龄29~42岁,美国麻醉医师协会分级(ASA)Ⅰ或Ⅱ级,患者随机分为4组(每组25例):帕瑞昔布钠(P组)和不同剂量芬太尼组(F1组、F2组、F3组)。所有患者术中采用丙泊酚复合芬太尼静脉麻醉。P组于气管导管拔出后5 min静脉注射帕瑞昔布钠40 mg术后镇痛;F1、F2、F3组于拔出气管导管后5 min采用微量注射泵静脉输入不同剂量芬太尼术后镇痛,F1组:0.25μg·kg^(-1)·h^(-1),F2组:0.5μg·kg^(-1)·h^(-1),F3组:1.0μg·kg^(-1)·h^(-1),持续输入时间4 h。评估拔出气管导管后10 min,2、4、8、12、24、48 h时VAS疼痛评分,Ramsay镇静评分,测量患者手术切口周围触压痛域;记录观察期恶心/呕吐、头晕、过度镇静、呼吸抑制发生情况。结果F1组、F2组与P组比较VAS评分、触压痛域均无统计学差异(P均>0.05);F3组在12~48 h时,VAS评分较高,触压痛域较大,差异有统计学意义(P均<0.05)。与P组比较,F3组术后48 h头晕发生率较高,差异有统计学意义(32%vs 0,P<0.05)。结论在腹腔镜胆囊切除术,芬太尼可能引起阿片诱发的痛觉过敏,且呈现剂量依赖性。

Objective To observe the dose-effect relation of fentanyl on postoperative hyperalgesia in patients undergoing laparoscopic eholecystectomy. Methods A total of 100 male patients aged 29 to 42 years old with American Society of Anesthesiologists （ASA） class Ⅰ or Ⅱ receiving scheduled laparoscopic cholecysteetomy were selected and randomly divided into four groups （ n = 25, each） ： parecoxib sodium group （ group P） and groups of different doses of fentanyl（ groups F1, F2, F3 ）. The intravenous anesthesia of propofol combined with fentanyl was used during operation in all patients. For postoperative analgesia, intravenous injection of 40 mg parecoxib sodium was given in group P, and intravenous injection of different doses of fentanyl was respectively given with a mieroinjection pump in groups F1 （0.25 μg·kg^-1·h^-1 ）, F2 （ 0. 5μg·kg^-1·h^-1） and F3 （ 1.0μg·kg^-1·h^-1） for hours at 5-rain after tracheal catheter was drawn out. The visual analogue scale （VAS） pain score and Ramsay sedation score were evaluated at 10-min, 2,4,8,12,24 and 48 h after tracheal catheter was drawn out. The area of allodynia around surgical incision was measured. Nausea and vomiting, dizziness, excessive sedation and respiratory depression were recorded during observation period. Results There were no significant differences in VAS score and area of allodynia between groups F1, F2 and group P （ all P 〉 0.05 ）. Compared with group P, the VAS score was higher, the area of allodynia was greater at postoperative 12 h to 48 h, and the incidence of dizziness was significantly higher at postoperative 48 h in group F3 （ all P 〈 0.05 ）. Conclusion In laparoscopic cholecystectomy,fentanyl may cause opioid-induced hyperalgesia （OIH） with dose dependent.