右美托咪定复合七氟烷全身麻醉对腹腔镜胆囊手术术后恢复的影响  

Effect of general anesthesia with sevoflurane and on postoperative recovery for patients for undergoing laparoscopic cholecystectomy

作　　者：付俊[1] 冉然[1] 潘雪莲[1] 顾俊峰[1] 钟和英[1] 

机构地区：[1]湖北医药学院附属人民医院麻醉科,湖北十堰442000

出　　处：《中国医师进修杂志》2013年第9期16-19,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的比较右美托咪定（DEX）和瑞芬太尼（REM）复合七氟烷（SEV）全身麻醉对腹腔镜胆囊手术患者术后恢复的影响。方法将60例行腹腔镜胆囊手术患者（ASA分级Ⅰ～Ⅱ级）按随机数字表法分为DEX复合SEV全身麻醉组（DEX组）和REM复合SEV全身麻醉组（REM组），每组30例。观察两组患者首次吸气、睁眼、拔气管导管、定向力恢复和首次肛门排气时间等，及术后不同时间点生命体征、疼痛强度数字评分（NRS）、Ramsay评分和不良反应，评估患者、麻醉后恢复室护士和外科医生对恢复质量的满意度。结果DEX组较REM组拔气管导管和首次肛门排气时间短[（12．0±3．9）min比（15．9±5．6）min，t=-3．130，P=0．003；（18．5±3．4）h比（23．6±5．8）h，t=-5．455，P=0．000]，睁眼和定向力恢复时间长[（15．5±4．2）min比（11．7±2．9）min，t=4．078，P=0．000；（19．5±4．5）min比（14．8±3．6）min，t=4．315，P：0．000]。术后2h内，DEX组Ramsay评分较REM组高（P〈0．05），而NRS较REM组低（P〈0．05），需要追加镇痛药的患者较REM组少（2例比9例，P〈0．05oDEX组较REM组术后寒战和恶心呕吐发生率低[3．3％（1／30）比33．3％（10／30）、6．7％（2／30）比30．O％（9／30），P〈0．05oDEX组较REM组患者对恢复质量的满意度评分和麻醉后恢复室护士对恢复质量的满意度评分高[89．0（72．0—100．0）分比80．0（70．0—95．0）分，Z=-4．066，P=0．000；92．0（80．0～99．0）分比90．0（80．0—95．0）分，Z=-2．906，P=0．004]，但REM组较DEX组外科医生对恢复质量的满意度评分高[（91．8±5．8）分比（81．7±6．1）分，t=-6．568，P=0．004]。结论与REM复合SEV全身麻醉比较，DEX复合SEV全身麻醉可加快患者腹腔镜胆囊手术后呼吸和肛门排气的恢复，减轻疼痛，减少恶心呕吐、寒战发生，提高恢复质量。Objective To compare the effects of dexmedetomidine （DEX） and remifentainil （REM） combined with sevoflurane （SEV） for general anesthesia on recovery quality in patients undergoing laparoscopic cholecystectomy （LC）. Methods Sixty patients （ASA grade Ⅰ - Ⅱ ） who underwent LC were divided into DEX combined with SEV for general anesthesia group （DEX group） and REM combined with SEV for general anesthesia group （REM group） by table of random digit, with 30 cases each. Time of first inspiration,eye opening,extubation, orientation recovery and passage of gas by anus were recorded. Vital sign, numeric rating score （NRS）, Ramsay score and untoward reaction were recorded. Degree of satisfaction of patients,post-anesthesia care unit （PACU） nurse and surgeon were evaluated. Results The time of extubation and passage of gas by anus in DEX group were significantly shorter than those in REM group [（12.0 ±3.9） min vs. （15.9 ±5.6） min,t =-3.130,P=0.003; （18.5 ±3.4） h vs. （23.6 ±5.8） h,t = -5.455,P =0.000]. However,the time of eye opening and orientation recovery in DEX group were significantly longer than those in REM group [ （ 15.5± 4.2 ） min vs. （ 11.7 ± 2.9 ） min, t = 4.078, P = 0.000; （ 19.5 ± 4.5） rain vs. （ 14.8 ± 3.6） min,t = 4.315 ,P = 0.000]. During the first 2 h after operation,Ramsay score in DEX group was significantly higher than that in REM group （P 〈 0.05 ）, but NRS in DEX group was significanty lower than that in REM group （P 〈 0.05 ）, the patients with additional analgesics was minor than REM group （2 cases vs. 9 cases,P 〈 0.05 ）. The percentages of patients suffering shivering and postoperative nausea and vomiting in DEX group were significantly lower than those in REM group [ 3.3%（1/30） vs. 33.3% （10/30）,6.7%（2/30） vs. 30.0%（9/30）,P 〈0.05]. Degree of satisfaction of patients and PACU nurse in DEX group were higher than those in REM group [89.0（72.0-100.0） scores vs. 80.0（70.0-95.0） scores,

关 键 词：恢复期 麻醉 腹腔镜 七氟烷 

分 类 号：R614[医药卫生—麻醉学]