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0.25 μg/(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。
Abstract
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.
关键词
胆囊切除术 /
小剂量纳洛酮 /
瑞芬太尼 /
痛觉敏化
Key words
cholecystectomy /
low-dose Naloxone /
remifentanil /
hyperalgesia
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参考文献
[1] Manchikanti L, Fellows B, Ailinani H, et al. Therapeutic use, abuse, and nonmedical use of opioids: a ten year perspective[J]. Pain Physician, 2010,13: 401-435.
[2] 赵丽云,叶铁虎,张银中,等.小剂量纳洛酮在术后吗啡静脉自控镇痛中的应用[J]. 中国医学科学院学报, 2005, 27(2): 228-231.
[3] 高明龙,文爱平,李爱珍,等. 吗啡联合不同剂量纳洛酮用于剖腹产病人术后镇痛[J]. 山西医科大学学报, 2007, 38(8): 741-744.
[4] Karube N, Ito S, Sako S, et al. Sedative effects of oral pregabalin premedication on intravenous sedation using propofol target-controlled infusion[J]. Anesth, 2017, 31(4): 586-592.
[5] Mauermann E, Filitz J, Dolder P, et al. Does fentanyl lead to opioid-induced hyperalgesia in healthy volunteers? a double-blind, randomized, crossover trial[J]. Anesthesiology, 2016, 124: 453-463.
[6] Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a metaanalysis[J]. Br J Anaesth, 2014, 112: 991-1004.
[7] Tompkins D A, Smith M T, Bigelow G E, et al. The effect of repeated intramuscular alfentanil injections on experimental pain and abuse liability indices in healthy males[J]. Clin J Pain, 2014, 30: 36-45.
[8] Zhang L, Shu R, Zhao Q, et al. Preoperative butorphanol and flurbiprofen axetil therapy attenuates remifentanil-induced hyperalgesia after laparoscopic gynaecological surgery: a randomized double-blind controlled trial[J]. Br J Anaesth, 2016, 117(4): 504 -511.
[9] Tong J G. Poorly controlled postoperative pain: prevalence, consequences, and prevention[J]. J Pain Res, 2017, 10:2287-2298.
[10] McDonnell C, Zaarour C, Hull R, et al. Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia[J]. Can J Anaesth, 2008, 55(12): 813-818.
[11] Leal P C, Salomão R, Brunialti M K, et al. Evaluation of the effect of ketamine on remifentanil-induced hyperalgesia: a double-blind, randomized study[J]. Clin Anesth, 2015, 27(4): 331-337.
[12] Yalcin N, Uzun S T, Reisli R, et al. A comparison of ketamine and paracetamol for preventing remifentanil induced hyperalgesia in patients undergoing total abdominal hysterectomy [J]. Int J Med Sci, 2012, 9(5): 327 -333.
[13] Schlimp C J, Pipam W, Wolrab C, et al. Clonidine for remifentanil-induced hyperalgesia: a double-blind randomized, placebo-controlled study of clonidine under intra-operative use of remifentanil in elective surgery of the shoulder[J]. Schmerz, 2011, 25(3): 290-295.
[14] 刘晴晴,刘永哲,高明龙,等. α2肾上腺素受体对术后痛觉敏化的调控[J]. 武警医学, 2018, 29(2): 201 -203.
基金
北京市科技计划基金资助项目(Z151100003915089)
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