艾司洛尔对高血压患者经腹腔镜胆囊切除术后治疗效应的研究  

The effects of intraoperative use of esmolol on patients with hypertension undergoing laparoscopic cholecystectomy

作　　者：王其敏[1] 宋琼[1] 

机构地区：[1]郑州市中心医院麻醉科,河南450007

出　　处：《中国临床新医学》2011年第2期118-120,共3页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

摘　　要：目的研究高血压患者行腹腔镜胆囊切除术围手术期输注艾司洛尔对术后疼痛和恶心呕吐(PONV)的影响。方法收集我院ASAⅡ合并血压控制良好的高血压病人50例,随机分为艾司洛尔组和对照组。艾司洛尔组麻醉诱导前立即给予艾司洛尔1 mg·kg^(-1)静注,术中给予5～10μg·kg^(-1)·min^(-1)静脉持续注入,心率控制在65～75次/min,对照组诱导前及术中均给予同等容积的林格氏液,拔出气管插管后立即停用。术后分别用VAS法评估疼痛程度和4分法评价PONV情况。结果术中艾司洛尔有明显的镇痛效应(P<0.01),术后艾司洛尔组需止吐药明显减少,其中9例病人没有使用止吐药;而对照组所有病人至少使用一次止吐药,两组比较差异有统计学意义(P<0.01)。PONV发生频率与瑞芬太尼、丙泊酚、女性、吸烟、既往PONV和运动疾病没有相关性。并且术后艾司洛尔组镇痛剂用量较对照组少(P<0.05)。结论艾司洛尔在腹腔镜胆囊切除术术中和术后有明显镇痛作用,并且在联合瑞芬太尼的情况下,能够降低早期PONV的发生。Objective To investigate beneficial effects of esmolol on postoperative pain, postoperative nausea and vomiting （PONV） in controlled hypertensive patients undergoing laparoseopic cholecysteetomy. Methods Fifty consecutive ASA class Ⅱ patients with controlled hypertension undergoing laparoscopic cholecystectomy were randomized into two groups. The esmolol group （Group E, n =25） was given intravenous injection of 1 mg·kg-1 bolus of esmolo and the placebo group （ Group P, n = 25 ） was given an identical volume of Ringer＇ s lactate. The rate of esmo]ol infusion was 5 - 10 μg · kg-1 · min-1 throughout the procedure and was adjusted to keep the heart rate between 65 -75 beats/rain. After pulling out the trached intubation drug use was stopped. After operation, patients reported the nausea using a four-point scale. Results Esmolol had an opioid-sparing effect intraoperativcly （P 〈 0. 01 ）. Postoperative requirements for antiemetics were significantly less in the esmolol group, with no antiemecties given to nine patients. In the placebo group, however, all patients required at least one close of antiemetic （P 〈 0. 01 ）. The frequency of PONV did not correlate to the amounts of rcmifentanil, propofol, postsperative antiemeties consumed, or to female gender, non-smoking status, and history of PONV or motion sickness. Postoperative analgesic consumption in Group E was significandy lower than that in Group P （P 〈 0. 05）. Conclusion Esmolol has an opioid-sparing effect in the intraoperative and immediated postoperative period in hypertensive patients undergoing laparoscopy. When combined with remifentanil, it is more effective than placebo in decreasing early PONV.

关 键 词：麻醉 术后恶心呕吐 镇痛 腹腔镜手术 

分 类 号：R657.4[医药卫生—外科学]