手术末期瑞芬太尼逐级撤药可以减轻颈椎手术患者术后痛觉过敏
|
摘要
目的观察手术末期瑞芬太尼逐级撤药减轻骨科手术患者术后痛觉过敏的效果。方法选择2017年3至12月在本院择期行颈椎手术的患者80例,男45例,女35例,年龄20～55岁,BMI 18.5～24 kg/m~2,ASAⅡ或Ⅲ级。按照随机数字表法将患者分为逐级撤药组(G组)和立即撤药组(A组),每组40例。患者入室后进行常规监测,所有患者均行静脉麻醉,静脉泵注丙泊酚6～8 mg·kg~(-1)·h~(-1)和瑞芬太尼0.08～0.20μg·kg~(-1)·min~(-1),在手术结束时,G组瑞芬太尼持续泵入,每5分钟泵入量减少麻醉维持量的三分之一,于术后15 min停止泵入;A组在术后立即停止瑞芬太尼的泵入。在麻醉诱导前和术后1、2、6、24 h进行机械痛阈值测定,记录术后1、2、6、24 h的VAS评分,以及患者术后0～1、1～2、2～6、6～24 h时段舒芬太尼用量,记录患者术后苏醒时间、意识恢复时间、术后拔管时间以及术后恶心、呕吐、呼吸抑制、低血压和寒战等不良反应的发生情况。结果与麻醉诱导前比较,术后1、2 h A组患者机械痛阈值明显降低(P<0.05),G组患者不同时点机械痛阈值差异无统计学意义。术后1、2 h G组患者VAS评分明显低于A组(P<0.05)。术后0～1、1～2 h G组患者舒芬太尼用量明显低于A组(P<0.05),且术后PACU舒芬太尼追加次数明显少于A组(P<0.05)。两组患者术后苏醒时间、意识恢复时间和术后拔管时间差异无统计学意义。G组患者术后恶心呕吐、呼吸抑制的发生率明显低于A组(P<0.05)。两组患者低血压、寒战的发生情况差异无统计学意义。结论手术末期瑞芬太尼逐级撤药可以减轻颈椎手术患者术后痛觉过敏,降低患者术后疼痛感,并减少术后恶心呕吐、呼吸抑制的发生。
Objective To investigate the effect of gradual withdrawal of remifentanil on postoperative hyperalgesia in patients undergoing cervical spine surgery. Methods Eighty patients undergoing elective cervical spine surgery were assigned into two groups according to the table of random number: the gradual withdrawal group(group G) and the abrupt withdrawal group(group A), including 45 males and 35 females, aged 20-55 years, BMI 18.5-24 kg/m~2, ASA physical status Ⅱ-Ⅲ, 40 cases in each group. The vital signs were monitored and the intravenous anesthesia was performed. All the patients were treated with 0.2 μg·kg~(-1)·min~(-1) remifentanil and 4-12 mg·kg~(-1)·h~(-1) propofol. At the end of the surgery, anesthesia maintenance of remifentanil in group G gradually reduced by one-third of that during surgery per five minutes and stoped at 15 minutes after surgery. Group A stopped abruptly after surgery. The threshold of mechanical pain was detected before induction and 1, 2, 6 and 24 h after surgery. The VAS score were recorded at 1, 2, 6 and 24 h after surgery and the sufentanil consumption were recorded simultaneously. The awakening time, consciousness recovery time and extubation time of patients were recorded. The adverse reactions such as nausea, vomiting, respiratory inhibition, hypotension and chills after operation were recorded. Results The mechanical pain thresholds at 1 and 2 h after operation in group A were decreased significantly(P < 0.05), while the mechanical pain thresholds in group G were not significantly changed after surgery. The VAS scores at 1 and 2 h after operation and the postoperative consumption of sufentanil in 0-1,1-2 h periods after surgery in group G were significantly lower than those in group A(P < 0.05). There was no significant difference in awakening time, consciousness recovery time, postoperative extubation time between two groups. The incidence of nausea and respiratory inhibition was significantly decreased in group G compared with group A. Conclusion Gradual withdrawal of remifentanil in the end of operation may prevent opioid-induced hyperalgesia in patients undergoing orthopaedic operation,reduce postoperative pain and the incidence of nausea, vomiting and postoperative respiratory depression.
Objective To investigate the effect of gradual withdrawal of remifentanil on postoperative hyperalgesia in patients undergoing cervical spine surgery. Methods Eighty patients undergoing elective cervical spine surgery were assigned into two groups according to the table of random number: the gradual withdrawal group(group G) and the abrupt withdrawal group(group A), including 45 males and 35 females, aged 20-55 years, BMI 18.5-24 kg/m~2, ASA physical status Ⅱ-Ⅲ, 40 cases in each group. The vital signs were monitored and the intravenous anesthesia was performed. All the patients were treated with 0.2 μg·kg~(-1)·min~(-1) remifentanil and 4-12 mg·kg~(-1)·h~(-1) propofol. At the end of the surgery, anesthesia maintenance of remifentanil in group G gradually reduced by one-third of that during surgery per five minutes and stoped at 15 minutes after surgery. Group A stopped abruptly after surgery. The threshold of mechanical pain was detected before induction and 1, 2, 6 and 24 h after surgery. The VAS score were recorded at 1, 2, 6 and 24 h after surgery and the sufentanil consumption were recorded simultaneously. The awakening time, consciousness recovery time and extubation time of patients were recorded. The adverse reactions such as nausea, vomiting, respiratory inhibition, hypotension and chills after operation were recorded. Results The mechanical pain thresholds at 1 and 2 h after operation in group A were decreased significantly(P < 0.05), while the mechanical pain thresholds in group G were not significantly changed after surgery. The VAS scores at 1 and 2 h after operation and the postoperative consumption of sufentanil in 0-1,1-2 h periods after surgery in group G were significantly lower than those in group A(P < 0.05). There was no significant difference in awakening time, consciousness recovery time, postoperative extubation time between two groups. The incidence of nausea and respiratory inhibition was significantly decreased in group G compared with group A. Conclusion Gradual withdrawal of remifentanil in the end of operation may prevent opioid-induced hyperalgesia in patients undergoing orthopaedic operation,reduce postoperative pain and the incidence of nausea, vomiting and postoperative respiratory depression.
引文
[1] Machado ML,Soares JHN,Kuster de Albuquerque Gress MA,et al.Dose-finding study comparing three treatments of remifentanil in cats anesthetized with isoflurane undergoing ovariohysterectomy.J Feline Med Surg,2018,20(2):164-171.
[2] 刘健萍,陈茜,蓝雨雁.全凭静脉麻醉下不同麻醉深度对下腹部剖腹手术患者术后痛觉过敏的影响.临床麻醉学杂志,2017,33(4):345-348.
[3] Yang M,Zhang J,Zhang F,et al.Preoperative and intraoperative continuous use of dexmedetomidine on hyperalgesia after patients' remifentanil anesthesia.Niger J Clin Pract,2017,20(2):244-247.
[4] Lee M,Silverman SM,Hansen H,et al.A comprehensive review of opioid-induced hyperalgesia.Pain physician,2011,14(2):145-161.
[5] Comelon M,Raeder J,Stubhaug A,et al.Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia.Br J Anaesth,2016,116(4):524-530.
[6] Santonocito C,Noto A,Crimi C,et al.Remifentanil-induced postoperative hyperalgesia:current perspectives on mechanisms and therapeutic strategies.Local Reg Anesth,2018,11:15-23.
[7] 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.Br J Anaesth,2016,117(4):504-511.
[8] Kim SH,Stoicea N,Soghomonyan S,et al.Remifentanil-acute opioid tolerance and opioid-induced hyperalgesia:a systematic review.Am J Ther,2015,22(3):e62-74.
[9] 张麟临,赵亓,王新,等.氟比洛芬酯复合地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果.中华麻醉学杂志,2016,36(4):392-395.
[10] Braulio G,Passos SC,Leite F,et al.Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia:a randomized,double-blind clinical trial.Front Pharmacol,2018,9:94.
[11] Mercieri M,Palmisani S,De Blasi RA,et al.Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion:a double-blind,randomized,active-controlled trial.Br J Anaesth,2017,119(4):792-802.
[12] Trafton JA,Abbadie C,Marek K,et al.Postsynaptic signaling via the [mu]-opioid receptor:responses of dorsal horn neurons to exogenous opioids and noxious stimulation.J Neurosci,2000,20(23):8578-8584.
[13] Angst MS,Koppert W,Pahl I,et al.Short-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal.Pain,2003,106(1-2):49-57.
[2] 刘健萍,陈茜,蓝雨雁.全凭静脉麻醉下不同麻醉深度对下腹部剖腹手术患者术后痛觉过敏的影响.临床麻醉学杂志,2017,33(4):345-348.
[3] Yang M,Zhang J,Zhang F,et al.Preoperative and intraoperative continuous use of dexmedetomidine on hyperalgesia after patients' remifentanil anesthesia.Niger J Clin Pract,2017,20(2):244-247.
[4] Lee M,Silverman SM,Hansen H,et al.A comprehensive review of opioid-induced hyperalgesia.Pain physician,2011,14(2):145-161.
[5] Comelon M,Raeder J,Stubhaug A,et al.Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia.Br J Anaesth,2016,116(4):524-530.
[6] Santonocito C,Noto A,Crimi C,et al.Remifentanil-induced postoperative hyperalgesia:current perspectives on mechanisms and therapeutic strategies.Local Reg Anesth,2018,11:15-23.
[7] 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.Br J Anaesth,2016,117(4):504-511.
[8] Kim SH,Stoicea N,Soghomonyan S,et al.Remifentanil-acute opioid tolerance and opioid-induced hyperalgesia:a systematic review.Am J Ther,2015,22(3):e62-74.
[9] 张麟临,赵亓,王新,等.氟比洛芬酯复合地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果.中华麻醉学杂志,2016,36(4):392-395.
[10] Braulio G,Passos SC,Leite F,et al.Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia:a randomized,double-blind clinical trial.Front Pharmacol,2018,9:94.
[11] Mercieri M,Palmisani S,De Blasi RA,et al.Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion:a double-blind,randomized,active-controlled trial.Br J Anaesth,2017,119(4):792-802.
[12] Trafton JA,Abbadie C,Marek K,et al.Postsynaptic signaling via the [mu]-opioid receptor:responses of dorsal horn neurons to exogenous opioids and noxious stimulation.J Neurosci,2000,20(23):8578-8584.
[13] Angst MS,Koppert W,Pahl I,et al.Short-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal.Pain,2003,106(1-2):49-57.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |