不同电针输出波形对瑞芬太尼诱发患者术后痛觉过敏的影响

Effects of electroacupuncture with different wave forms on remifentanil-induced hyperalgesia after surgery

目的评价不同电针输出波形对瑞芬太尼诱发患者术后痛觉过敏的影响。方法择期脾切除术患者80例,年龄18~50岁,ASA分级Ⅰ或Ⅱ级,BMI18~25kg/m^2,采用随机数字表法分为4组(n=20):瑞芬太尼组(R组)、疏密波+瑞芬太尼组(DR组)、连续波+瑞芬太尼组(CR组)和断续波+瑞芬太尼组(IR组)。于麻醉诱导前30min,DR组、CR组和IR组电针刺激合谷、三阴交穴,分别调节电针刺激参数:疏密波1mA+2/15Hz,连续波1mA+15Hz,断续波1mA+15/0Hz持续刺激1h,刺激结束后留针至手术结束。离开麻醉恢复室后,采用舒芬太尼150μg和托烷司琼8mg行PCIA,溶于150ml生理盐水中,背景输注速率2ml/h,PCA剂量1ml,锁定时间20min,镇痛48h,维持VAS评分<4分。当VAS评分≥4分时静脉注射地佐辛5mg进行补救镇痛。记录术中瑞芬太尼用量;记录术后48h内舒芬太尼用量和补救镇痛情况;记录术后48h时舒适度评分和切口周围痛阈。结果4组术中瑞芬太尼用量差异无统计学意义(P>0.05)。与R组比较,DR组、CR组和IR组舒芬太尼用量减少,舒适度评分和切口周围痛阈升高,恶心呕吐发生率降低,DR组补救镇痛率降低(P<0.05),CR组和IR组差异无统计学意义(P>0.05);与DR组比较,CR组和IR组舒芬太尼用量增多,补救镇痛率升高,舒适度评分和切口周围痛阈降低(P<0.05);CR组和IR组间上述各指标比较差异无统计学意义(P>0.05)。DR组、CR组和IR组间不良反应发生率比较差异无统计学意义(P>0.05)。结论疏密波输出电针刺激抑制瑞芬太尼诱发患者术后痛觉过敏的效果最佳。

Objective To evaluate the effects of electroacupuncture(EA)with different wave forms on remifentanil-induced hyperalgesia after surgery. Methods A total of 80 patients, aged 18-50 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with body mass index of 18-25 kg/m^2, scheduled for elective splenectomy, were divided into 4 groups(n=20 each)using a random number table method: remifentanil group(group R), disperse-dense wave plus remifentanil group(group DR), continuous wave plus remifentanil group(group CR), and intermittent wave plus remifentanil group(group IR). In CR, DR and IR groups, Hegu and Sanyinjiao acupoints were stimulated for 1 h with disperse-dense wave(1 mA, 2/15 Hz), continuous wave(1 mA, 15 Hz)and intermittent wave(1 mA, 15/0 Hz), respectively, starting from 30 min before induction of anesthesia.The needle was reserved in the acupuncture points from the end of stimulation until the end of surgery.Patient-controlled intravenous analgesia was performed for 48 h with sufentanil 150 μg and tropisetron 8 mg dissolved in 150 ml of normal saline after leaving the postanesthesia care unit.Patient-controlled analgesia pump was programmed to deliver a 1 ml bolus dose with a lockout interval of 20 min and background infusion at 2 ml/h, and visual analogue scale score was maintained<4.Decozine 5 mg was intravenously injected as rescue analgesic when visual analogue scale score≥4.The consumption of intraoperative remifentanil and consumption of sufentanil and requirement for rescue analgesic within 48 h after surgery were recorded.Patients′ comfort was assessed and scored, and the pain threshold around the incision site was recorded at 48 h after surgery. Results There were no significant differences in the consumption of intraoperative remifentanil among the four groups(P>0.05). Compared with group R, the consumption of sufentanil was significantly reduced, the comfort score and pain threshold around the incision site were increased, and the incidence of nausea and vomiting was decreased in DR, CR and IR groups, the requirement for rescue analgesic was significantly decreased in group DR(P<0.05), and no significant change was found in the parameters mentioned above in CR and IR groups.There was no significant difference in the incidence of adverse reactions among DR, CR and IR groups(P>0.05). Conclusion EA with disperse-dense wave stimulation can provide optimal efficacy in inhibiting remifentanil-induced hyperalgesia after surgery.