国际麻醉学与复苏杂志   2015, Issue (3): 10-10
    
术前定量测定舒芬太尼敏感性用于预测术后镇痛药物需要量
王恒跃, 陈辉, 许华, 熊源长1()
1.第二军医大学附属长海医院麻醉科
The use of preoperative quantitative pain sensitivity to sufentanil to predict postoperative analgesic consumption
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摘要:

【摘要】目的评估术前定量测定患者对舒芬太尼的敏感程度用于预测术后镇痛药物需要量的准确性。方法择期全麻下行直肠癌经腹前切除术男性患者50例,ASA分级Ⅰ-Ⅱ级,年龄27-65岁,BMI18-30kg/m2。在安静的环境下PainVision测量患者基础的痛阈(PT0),耐痛阈(PTT0)。面罩吸氧3min后,TCI(Gepts药代动力学模型)给药舒芬太尼效应室靶浓度为0.2ng/ml,患者效应室靶浓度达到目标浓度3min后测量痛阈(PT1)、耐痛阈(PTT1)。诱导后气管插管,静吸复合全麻。术毕接静脉镇痛泵。术后24h内观察患者疼痛情况、镇痛泵有效按压次数和舒芬太尼消耗的总量。结果给药后的耐痛阈与24小时镇痛泵有效按压次数和镇痛泵舒芬太尼的消耗量之间呈一定的负相关关系,r分别为-0.31、-0.34(P<0.05);给药后耐痛阈的增幅与24小时镇痛泵有效按压次数和镇痛泵舒芬太尼的消耗量呈明显负相关,r分别为-0.89、-0.90(P<0.05)。结论PainVision可以定量评估患者对舒芬太尼的敏感性,给药后患者耐痛阈的增幅可作为术后患者镇痛药物需要量的主要预测指标。

关键词: 【关键词】痛阈;耐痛阈;术后镇痛;舒芬太尼
Abstract:

【Abstract】ObjectiveTo evaluate the reliability of quantitative painsensitivity to theopoids method for the predictionof the postoperative analgesic durgs consumption.MethodsFifty ASAⅠor Ⅱmale patients, aged 27-65, with the body mass index range from 18-30 kg/m2 undergoing Dixon were enrolled in this study.All the patient were tested the pain threshold (PT0), pain tolerance threshold (PTT0) by PainVision in a quiet environment as a baseline.After the oxygen for 3 minutes, the target-controlled concentration of sufentanil in effective site was set at 0.2ng/ml, and theTCI was continued for 3 minutes before testing the pain threshold (PT1), pain tolerance threshold (PTT1), and then all the patient were intubated, the operation was maintained by intravenous inhalational anesthesia, and the PCA pump was connected when the operation was over meanwhile the sufentanil injection was stopped.Pain scores, the effective press times and the consumption of sufentanil in 24 hours after operation were recored.ReslutsThe pain tolerance threshold after sufentanil were negatively correlated with the press times of PCA (r=-0.31) and the consumption of sufentanil (r=-0.34), the increase of pain tolerance thresholdafter sufentanil were significantly negatively correlated with the press times of PCA (r=-0.89) and the consumption of sufentanil (r=-0.90). Conclusion ThePainVisioncan be applied to evaluatethe quantitative pain sensitivity tosufentanil, and the degree of increase in thepain tolerance threshold after sufentanil can be used to as the main parameter topredict the demand of postoperative analgesic drugs.

Key words: 【Key words】Pain threshold; Pain tolerance threshold ;postoperative analgesia; sufentanil