全身麻醉患者术前内源性阿片肽、痛觉敏感度及术中瑞芬太尼消耗量相关性研究*

The Correlation study of preoperative endogenous opioid peptides, pain sensitivity and intraoperative remifentanil consumption in patients with general anesthesia

摘要:

目的 探究全麻患者围术期痛觉敏感度、内源性阿片肽变化与术中瑞芬太尼消耗量影响因素相关性分析。方法 选择静脉全身麻醉下行腰椎后路减压椎间植骨融合术(posterior lumbar interbody fusion,PLIF)患者72例。于手术麻醉前(T1)、麻醉恢复后30min(T2)分别采集非输液侧肘静脉血3ml,采用酶联免疫法(enzyme-linked immuno sorbent assay, ELISA)测定血清中β-内啡肽(β-endorphin,β-EP)、亮氨酸脑啡肽(leuthine enkephalin, LEK)和强啡肽(dynorphin, DYN)含量。手术麻醉前(T1)、手术后24小时(T3)采用定量感觉检查(quantitive sensor testing, QST)分别测定热痛阈值、热耐痛阈值、缺血痛阈值、缺血耐痛阈值和机械痛阈值。记录患者麻醉过程中瑞芬太尼消耗量(单位：ug·kg-1·min-1)。 结果 与T1相比较,T2时患者血清β-EP、LEK、DYN水平明显降低(P＜0.05,P＜0.001,P＜0.001)；与T1相比较,T3时患者热痛阈、缺血痛阈、机械痛阈明显降低(P＜0.001,P＜0.001,P＜0.001),热耐痛阈、缺血耐痛阈也明显降低(P＜0.001,P＜0.001)。T1时患者缺血痛阈及机械痛阈水平与术前β-EP、LEK水平呈显著正相关；术中瑞芬太尼消耗量与T1时患者β-EP水平呈显著正相关。结论 全麻腰椎手术患者术后血清β-EP、LEK、DYN和疼痛阈值明显降低,患者术前缺血痛阈、机械痛阈与血清β-EP及LEK明显相关,且术中瑞芬太尼消耗量与术前血清β-EP呈显著正相关。

Abstract:

Objective To explore the correlation of perioperative pain sensitivity, endogenous opioid peptide changes and intraoperative remifentanyil consumption in orthopedic lumbar surgery patients with general anesthesia. Methods Seventy two patients undergoing PLIF with intravenous general anesthesia were selected. 3ml of blood from the non-infusion side elbow vein was collected before anesthesia (T1) and 30min after anesthesia recovery (T2). The serum levels ofβ- EP, LEK and DYN were measured by ELISA. The thermal pain threshold, thermal pain tolerance threshold, ischemic pain threshold, ischemic pain tolerance threshold and mechanical pain threshold was measured by QST respectively before anesthesia (T1) and 24 hours after operation (T3). The consumption of remifentanil during anesthesia was recorded. Results Compared with T1, the level of serumβ-EP,LEK,DYN decreased significantly at T2(P＜0.05,P＜0.001,P＜0.001); Compared with T1, the thermal pain threshold, ischemic pain threshold, mechanical pain threshold, thermal pain tolerance threshold and ischemic pain tolerance threshold were significantly reduced at T3(P＜0.001). Preoperative ischemic pain threshold and mechanical pain threshold were positively associated with serum β-EP and LEK; the intraoperative remifentanyl consumption was significantly positively associated with preoperative serum β-EP levels. Conclusion Postoperative serum β-EP, LEK, DYN and pain thresholds were significantly decreased in lumbar surgery patients with general anesthesia；patient ischemic pain threshold and mechanical pain threshold were significantly associated with preoperative serum β-EP and LEK. Moreover, there was a significant positive correlation between intraoperative remifentanyl consumption and preoperative serum β-EP.