持续静注小剂量纳洛酮对瑞芬太尼所致痛觉敏化的影响

Effect of continuous intravenous injection of low-dose naloxone on remifentanil induced hyperalgesia

目的探讨在胆囊切除术中持续静注小剂量纳洛酮对瑞芬太尼所致痛觉敏化的影响。方法选择120例进行胆囊切除术的患者,随机分为两组,对照组(生理盐水)和纳洛酮组[纳洛酮0.25μg/(kg·h)],麻醉诱导前15 min,至手术结束前5 min期间持续静注设计好的液体。测定术前和术后不同时间点的痛阈、VAS评分、Ramsay’s评分。结果组内比较,对照组术后0.5 h、1 h的痛阈值显著低于术前(P<0.05),术后2~24 h的痛阈值显著高于术前(P<0.01);纳洛酮组术后0.5~48 h的痛阈值显著高于术前的痛阈值(P<0.01),术后0.5~1 h的VAS评分显著高于术后2~24 h(P<0.01),而Ramsay’s评分显著低于术后2~24 h(P<0.01)。组间比较,纳洛酮组术后0.5~1 h的痛阈值、Ramsay’s评分显著高于对照组、VAS评分低于对照组(P<0.01)。结论全身麻醉中持续静注小剂量纳洛酮能够拮抗瑞芬太尼麻醉导致的术后痛觉敏化。

Objective To investigate the effect of continuous intravenous injection of low-dose naloxone on remifentanil-induced hyperalgesia. Methods One hundred and twenty patients undergoing cholecystectomy were randomly assigned to receive continuous i. v. of either normal saline（ group C） or naloxone 0. 25 μg/（ kg·h）（ group N） during maintenance of general anesthesia. Normal saline or naloxone was injected fifteen minutes before the induction of anesthesia until five minutes before the end of the operation.The pain threshold,Visual Analogue Score（ VAS） and Ramsay ＇s score were determined preoperatively（ T1） and postoperatively[0. 5 h（ T2）,1 h（ T3）,2 h（ T4）,8 h（ T5）,12 h（ T6）,24 h（ T7） and 48 h（ T8） ]. Results In group C,the pain threshold at T2 and T3 was significantly lower than at T1（ P〈0. 05）,and the pain threshold between T4 and T8 was significantly higher than at T1,（ P〈0. 01）. In group N,the pain threshold at different time points after operation was significantly higher than at T1（ P〈0. 01）,and the Visual Analogue Score at T2 and T3 was significantly higher than that of T4 to T8（ P〈0. 01）. The pain threshold and Ramsay＇s score at T2 and T3 in group N were significantly higher than those in group C,and the Visual Analogue Score at T2 and T3 was lower than in group C（ P〈0. 01）. Conclusions Continuous intravenous injection of low-dose naloxone during general anesthesia can help prevent remifentanil-induced hyperalgesia.