预防瑞芬太尼诱发术后痛觉过敏的处理措施

Intervention strategies for prevention of remifentanil - induced postoperative hyperalgesia

背景瑞芬太尼是一种超短效的阿片类药物，因其药效强、起效快、半衰期短和无蓄积等特点，广泛应用于临床麻醉中。但其诱发术后痛觉过敏发生率高，对术后管理非常不利。目的探讨预防瑞芬太尼诱发痛觉过敏（remifentanilinduced hyperalgesia，RIH）的治疗措施。内容系统回顾近年来RIH的机制，综述RIH的防治措施。趋向深入研究RIH的机制，为预防RIH的治疗措施提供新的思路。

Background Remifentanil is a ultra-short-acting μ-opioid receptor agonist. Because remifentanil possesses high efficacy, rapid onset, short half-life time and fast clearance, it has been widely used for anesthesia. However, the incidence of remifentanil-induced hyperalgesia （RIH） remains relatively high, which poses great challenges to postoperative management. Objective To explore the effective intervention strategy for the prevention of RIH. Content Like other opioid drugs, remifentanil, after repetitive and long-term administration, causes drug tolerance and pain hypersensitivity. RIH may follow central sensitization of both ascending and descending pathways to facilitate pain transduction. A large amount of clinical trials tried to prevent RIH using various medications, such as, agonists for α2-drenoreceptor, opioid drugs, antagonists for NMDA receptors, non-steroid anti- inflammatory drugs, and calcium channel blockers, etc. Trend Further studies in the field are required to advance the understanding of the development of RIH, which may result in better strategies to prevent and treat this condition.