CAJ | 학술논문

目的观察瑞芬太尼引起术后痛觉过敏的发生情况并筛选影响因素.方法选择2008年6-12月温州医学院附属第二医院术中使用瑞芬太尼和手术切口＜4 cm的全麻患者共1620例,分别在麻醉恢复室(PACU)、术后4 h及24 h记录痛觉过敏的发生情况,应用非条件Logistic回归模型分析与痛觉过敏可能有关的6个因素,即年龄、性别、麻醉维持方式、手术时间、手术部位和瑞芬太尼用量.结果 1620例患者共发生痛觉过敏261例(16.1%).年龄＜16岁的痛觉过敏发生率为25.9%,≥16岁为15.6%;男性痛觉过敏发生率为20.8%,女性为13.0%;手术时间＞2 h痛觉过敏发生率为32.7%,≤2 h为9.9%;瑞芬太尼用量＞30μg/kg痛觉过敏发生率为41.8%,≤30 μg/kg为4.8%,不同年龄、性别、手术时间及瑞芬太尼用量间比较,差异均有统计学意义(均P＜0.05).痛觉过敏各标准中肢体保护性动作存在及触、冷诱发痛两项发生率最高(39.0%,34.5%).Logistic回归分析结果显示,年龄＜16岁、男性、手术时间＞2 h和瑞芬太尼用量＞30 μg/kg与痛觉过敏的发生存在相关(均P＜0.05).结论年龄＜16岁、手术时间较长和瑞芬太尼用量偏多会增加痛觉过敏的发生,麻醉方法和手术部位不会影响痛觉过敏的发生.
목적 관찰서분태니인기술후통각과민적발생정황병사선영향인소.방법 선택2008년6-12월온주의학원부속제이의원술중사용서분태니화수술절구＜4 cm적전마환자공1620례,분별재마취회복실(PACU)、술후4 h급24 h기록통각과민적발생정황,응용비조건Logistic회귀모형분석여통각과민가능유관적6개인소,즉년령、성별、마취유지방식、수술시간、수술부위화서분태니용량.결과 1620례환자공발생통각과민261례(16.1%).년령＜16세적통각과민발생솔위25.9%,≥16세위15.6%;남성통각과민발생솔위20.8%,녀성위13.0%;수술시간＞2 h통각과민발생솔위32.7%,≤2 h위9.9%;서분태니용량＞30μg/kg통각과민발생솔위41.8%,≤30 μg/kg위4.8%,불동년령、성별、수술시간급서분태니용량간비교,차이균유통계학의의(균P＜0.05).통각과민각표준중지체보호성동작존재급촉、랭유발통량항발생솔최고(39.0%,34.5%).Logistic회귀분석결과현시,년령＜16세、남성、수술시간＞2 h화서분태니용량＞30 μg/kg여통각과민적발생존재상관(균P＜0.05).결론 년령＜16세、수술시간교장화서분태니용량편다회증가통각과민적발생,마취방법화수술부위불회영향통각과민적발생.
Objective To investigate the incidence of remifentanil-induced hyperalgesia and screen for the relevant influencing factors in the post-operative patients. Methods A total of 1620 patients from June 2008 to December 2008 in our hospital undergoing general anesthesia with remifentanil and whose length of operative incision was less than 4 cm were enrolled . The incidence of postoperative hyperalgesia was investigated and recorded at the timepoints of staying at post-anesthesia care unit ( PACU ), 4 h and 24 h postoperation respectively. The unconditional statistical analysis of Logistic regression was used to explore such possible influencing factors as age, gender, methods of general anesthesia, operative duration,operative sites and remifentanil dose. Results The incidence of postoperative remifentanil-induced hyperalgesia was 16.1% (n = 261 ). The incidence of postoperative hyperalgesia was significantly increased in patients ＜ 16 yrs (25.9%) vs ≥ 16 yrs ( 15.6% ) (P ＜ 0.05), males vs females (20.8% vs 13.0%,P＜0.01), operative duration ＞2 h (32.7%) vs ≤ 2 h (9.9%) (P＜0.01) and remifentanil dose ＞30 μg/kg (41.8%) vs ≤30 μg/kg (4.8%) (P ＜0.01 ). And the incidence of limb protective action,touch and cold-induced allodynia were the two highest indicators (39.0%, 34.5% ). Analysis of Logistic regression showed that ages under 16 years old, operative duration ＞2 h and remifentanil dose ＞30 μg/kg were relevant with hyperalgesia (all P ＜ 0.05 ). Conclusion Ages under 16 years old, operative duration and remifentanil dose are the risk factors for postoperative remifentanil-induced hyperalgesia. Neither methods of general anesthesia nor operative sites has any effect on the occurrence of hyperalgesia.