摘要
目的评价电针联合地佐辛对瑞芬太尼诱发患者术后痛觉过敏的影响。方法择期全麻下行腹腔镜胆囊切除术患者120例，ASA分级Ⅰ或Ⅱ级，年龄25～64岁，BMI 18～28 kg/m^2，性别不限，采用随机数字表法分为4组（n＝30）：对照组（C组）、地佐辛组（D组）、电针组（E组）和电针联合地佐辛组（E＋D组）。E组和E＋D组于麻醉诱导前30 min，采用电针刺激双侧合谷、内关、足三里和阳陵泉，刺激参数：连续波（4 Hz），刺激强度以患者能够耐受为宜；手术开始后，电针刺激参数改为疏密波（密波20 Hz，疏波4 Hz），维持至术毕。D组和E＋D组于术毕前20 min静脉注射地佐辛5 mg，C组和E组给予等容量生理盐水。麻醉恢复室期间VAS评分〉5分时，静脉注射地佐辛5 mg；术后1～48 h内VAS评分〉5分时，静脉注射酮咯酸氨丁三醇30 mg；记录术后48 h时内镇痛药的使用情况。分别于入室时、麻醉诱导前10 min、术后6、24和48 h时测量手术切口周围痛阈，并于术后6、24和48 h时记录手术切口周围痛觉过敏的范围。记录术后6、24和48 h内恶心呕吐的发生情况。结果与C组比较，E组和E＋D组术后各时点时切口周围痛阈升高，痛觉过敏范围缩小，D组、E组和E＋D组麻醉恢复室首次使用镇痛药物时间延长，D组术后6 h内镇痛药物使用率降低，E组术后6、24和48 h内镇痛药物使用率降低，术后6 h内恶心呕吐发生率降低，E＋D组术后各时点镇痛药物使用率及恶心呕吐发生率降低（P〈0.05）；与D组比较，E＋D组术后各时点手术切口周围痛阈升高，术后24和48 h时痛觉过敏范围缩小，麻醉恢复室首次使用镇痛药物时间延长，术后24和48 h内镇痛药使用率降低（P〈0.05）；与E组比较，E＋D组麻醉恢复室首次使用镇痛药物时间延长，术后24 h内镇痛药使用率降低（P〈0.05）。结论电针联合地佐辛减轻瑞芬太尼诱发患者术后痛觉过敏的效果优于两者单独应用。
Objective To evaluate the effect of electroacupuncture combined with dezocine on postoperative hyperalgesia induced by remifentanil in patients.Methods One hundred and twenty patients, of American Society of Anesthesiologists physical status ⅠorⅡ, aged 25-64 yr, with body mass index of 18-28 kg/m^2, undergoing laparoscopic cholecystectomy, were allocated into 4 groups（n=30 each）using a random number table： control group（group C）, dezocine group（group D）, electroacupuncture group（group E）and electroacupuncture plus dezocine group（group E＋ D）. In E and E＋ D groups, bilateral Hegu, Neiguan, Zusanli and Yanglinquan acupoints were stimulated with continuous waves（4 Hz）and then with disperse-dense waves（dense wave 20 Hz, disperse wave 4 Hz）after beginning of surgery until the end of surgery.Dezocine 5 mg was intravenously injected at 20 min before the end of surgery in D and E＋ D groups and the equal volume of normal saline was given instead of dezocine in C and E groups.When visual analog scale score in post-anesthesia care unit（PACU）〉5, dezocine 5 mg was intravenously injected.When visual analog scale score 〉5 within 1-48 h after surgery, ketorolac tromethamine 30 mg was intravenously injected.The pain threshold in the area around surgical incision was measured on admission to the operating room, at 10 min before anesthesia induction and at 6, 12, 24 and 48 h after surgery.The range of hyperalgesia in the area around surgical incision was recorded at 6, 24 and 48 h after surgery.The occurrence of nausea and vomiting was also recorded within 6, 24 and 48 h after surgery.Results Compared with group C, the pain threshold was significantly increased and the range of hyperalgesia was decreased in the area around surgical incision at each time point in E and E＋ D groups, the duration of the first requirement for analgesics in PACU was significantly prolonged in D, E and E＋ D groups, the requirement for analgesics was significantly decreased within 6 h after surgery in group D, the requirement for analgesics was significantly decreased within 6, 24 and 48 h after surgery, and the incidence of nausea and vomiting was decreased within 6 h after surgery in group E, and the requirement for analgesics and incidence of nausea and vomiting were significantly decreased at each time point in group E＋ D（P〈0.05）. Compared with group D, the pain threshold in the area around surgical incision was significantly increased at each time point, and the range of hyperalgesia in the area around surgical incision was decreased at 24 and 48 h after surgery, the duration of the first requirement for analgesics in PACU was prolonged, and the requirement for analgesics was decreased within 24 and 48 h after surgery in group E＋ D（P〈0.05）. Compared with group E, the duration of the first requirement for analgesics in PACU was significantly prolonged, and the requirement for analgesics was decreased within 24 h after surgery in group E＋ D（P〈0.05）.Conclusion Electroacupuncture combined with dezocine produces better efficacy than either alone in reducing postoperative hyperalgesia induced by remifentanil in patients.
作者
陆黎
朱洪生
Lu Li;Zhu Hongsheng(Department of Anesthesiology, Longhua Hospital, Shanghai 200032, Chin)
出处
《中华麻醉学杂志》
CSCD
北大核心
2017年第12期1434-1437,共4页
Chinese Journal of Anesthesiology
关键词
电针
镇痛药
阿片类
哌啶类
痛觉过敏
手术后并发症
Electroacupuncture
Analgesics, opioid
Piperidines
Hyperalgesia
Postoperative complications
