瑞芬太尼诱导痛觉过敏机制的研究进展
Research Progress on the Mechanism of Remifentanil-Induced Hyperalgesia
摘要: 瑞芬太尼作为一种常用的静脉麻醉药，具有快速代谢和无蓄积效应，但瑞芬太尼诱导的痛觉过敏(RIH)给围术期管理带来挑战。RIH表现为对轻微刺激的过度疼痛反应，包括机械性和热痛觉过敏，通常在使用瑞芬太尼后几小时或几天发生。其机制涉及中枢神经系统的过度敏化、免疫细胞激活和促炎细胞因子的释放。瑞芬太尼通过激活Toll样受体4 (TLR4)、NMDAR和AMPAR等受体，引发神经炎症反应，增强神经元对伤害性刺激的敏感性，从而引起痛觉过敏。理解RIH的机制有助于指导瑞芬太尼的合理使用，预防术后并发症。本文综述了RIH的机制及其对疼痛管理的影响，旨在优化围术期疼痛控制并改善患者恢复。
Abstract: Remifentanil, a commonly used intravenous anesthetic, is known for its rapid metabolism and lack of accumulation, but remifentanil-induced hyperalgesia (RIH) poses a challenge in perioperative management. RIH is characterized by an exaggerated pain response to mild stimuli, including mechanical and thermal hyperalgesia, which typically occurs within hours or days after remifentanil administration. The mechanism involves central sensitization, immune cell activation, and the release of pro-inflammatory cytokines. Remifentanil activates receptors such as Toll-like receptor 4 (TLR4), NMDAR, and AMPAR, triggering neuroinflammation, which enhances neuronal sensitivity to noxious stimuli, leading to hyperalgesia. Understanding the mechanisms of RIH helps guide the rational use of remifentanil and prevents postoperative complications. This review summarizes the mechanisms of RIH and its impact on pain management, aiming to optimize perioperative pain control and improve patient recovery.
文章引用：宁柳娴, 董朝轩. 瑞芬太尼诱导痛觉过敏机制的研究进展[J]. 临床医学进展, 2026, 16(3): 209-217. https://doi.org/10.12677/acm.2026.163781

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