瑞芬太尼诱发痛觉过敏作用的临床观察.docxVIP

上海交通大学 硕士学位论文 瑞芬太尼诱发痛觉过敏作用的临床观察 姓名：俞红丽 申请学位级别：硕士 专业：麻醉学 指导教师：于布为5-8pig/kg/min持续输注维持肌肉松弛。手术结束前30分钟，给予吗啡 0.15mg/kg；关腹膜前停止阿曲库鞍的输注；于手术结束时停止瑞芬太尼 和异丙酚的输注；芬太尼组术中按需追加芬太尼，手术结束30min前停 止追加，同样给予吗啡0.15mg/kgo拔管后送至苏醒室观察大约2小时， Steward苏醒评分大于4分后即刻及其后30min、60min 90min 2h、4h、 6h、24h进行VAS评分和手术切口周围疼痛阈值测定。用吗啡进行术后 PCA镇痛。 结果：术后VAS评分I组均低于II、III、IV、V组，P0.05o以Von Frey纤毛测定切口周围皮肤痛阈，瑞芬太尼组患者的痛阈显著低于芬太 尼组，P0.05o不同剂量瑞芬太尼组在苏醒后至2h, VAS评分均大于5 分，尤其是IV、V组在30、60min更其于II、III组；同样，Von Frey纤 毛测定异常疼痛IV、V组高于II、III组。术后24小时吗啡消耗量II 组高于I组，P0.05o镇痛泵按压次数IV、V、III组高于II、I组，P0.05o 结论：相对大剂量的瑞芬太尼增加患者术后早期对疼痛的敏感性，对 镇痛药物的需求量也更大。提示瑞芬太尼为主要镇痛药物的麻醉确实会 导致痛觉过敏和急性阿片的耐受，并有一定的剂量相关性。术后2h以后, 在各组间未再观察到明显的差异。因此，以瑞芬太尼为基础的麻醉，需 在停药前给予充分的镇痛措施，以改善术后的痛觉过敏状态，提高麻醉 后的苏醒和恢复质量。 关键词：瑞芬太尼，芬太尼，痛觉过敏，镇痛 CLINICAL OBSERVATION OF REMIFENTANIL INDUCED HYPERALGESIA ABSTRACT Background: Remifentanil is a short-acting opioid with a predictable and rapid recovery relatively independent of the dose? The short-acting nature of remifentanil, which provides rapid recovery from anesthesia, also results in the potentially rapid appearance of postoperative pain. Previous studies have revealed that short-acting opioid may result in a rapid development of acute tolerance in animals and is more likely to occur with large doses. To explore the mechanism of remifentanil induced hyperalgesia and to improve the recovery quality of propofol-remifentanil based total intravenous anesthesia (TIVA), we tested the hypothesis that intraoperative remifentanil administration may result in an acute opioid tolerance and may be manifested by increased postoperative pain and opioid requirement. Meanwhile these results were compared with fentanyl administration. Methods: One hundred female patients (aged 30-65 yr) ASA grade I-II, undergoing elective abdominal hysterectomy surgery with TIVA were enrolled in this study. They were randomly assigned to five groups: group I (fentanyl, n=20 as control), group II (remifentanil 0.05|ig/kg/min, n=20), group III (remifentanil 0」5|ig/kg/min,