不同麻醉方法对重症肌无力患者胸腔镜下胸腺切除术后急性疼痛的影响  

Effects of different anesthetic methods on postoperative acute pain in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy

作　　者：贾瑞芳[1] 孟小燕[1] 周淑珍[1] 石妤[1] 左明章[1] Jia Ruifang;Meng Xiaoyan;Zhou Shuzhen;Shi Yu;Zuo Mingzhang(Department of Anesthesiology,Beijing Hospital National Center of Gerontology,Bering 100730,China)

机构地区：[1]北京医院国家老年医学中心麻醉科,100730

出　　处：《中华麻醉学杂志》2018年第6期676-679,共4页Chinese Journal of Anesthesiology

摘　　要：目的 评价不同麻醉方式对重症肌无力患者胸腔镜下胸腺切除术后急性疼痛的影响.方法 择期拟行胸腔镜下胸腺切除术患者54例,性别不限,年龄18~64岁,体重指数20~ 28 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=27):七氟醚复合麻醉组(S组)和丙泊酚复合麻醉组(P组).2组患者常规诱导后,S组吸入七氟醚复合瑞芬太尼靶控输注维持麻醉;P组靶控输注丙泊酚复合瑞芬太尼维持麻醉.于术前(T0)、拔除气管导管后5和10 min(T1.2)时记录HR和MAP;记录T2时疼痛程度及术后1、2、4、24和48 h(T3-7)时VAS评分和吗啡用量;T7时记录镇痛泵按压次数、镇痛补救情况和恶心呕吐发生情况.结果 2组各时点HR和MAP差异无统计学意义(P>0.05).与S组比较,P组T2时疼痛程度减轻,T34时VAS评分和吗啡用量降低(P<0.05);2组T5-7时VAS评分和吗啡用量、T7时镇痛泵按压次数、镇痛补救率和恶心呕吐发生率差异无统计学意义(P>0.05).结论 丙泊酚复合麻醉对重症肌无力患者早期术后急性疼痛的缓解作用优于七氟醚复合麻醉.Objective To evaluate the effects of different anesthetic methods on postoperative acute pain in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy.Methods Fifty-four patients of both sexes,aged 18-64yr,with body mass index of 20-28kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective video-assisted thoracoscopic thymectomy, were allocated into 2groups (n =27each)using a random number table method:sevoflurane-based anesthesia group (group S)and propofol-based anesthesia group (group P).After routine anesthesia induction in two groups,anesthesia was maintained by inhaling sevoflurane and target-controlled infusion of remifentanil in group S and by target-controlled infusion of propofol and remifentanil in group P.Heart rate and mean arterial pressure were recorded before operation and at 5and 10min after extubation (T1,2).The intensity of pain at T2and visual analog scale (VAS)score and consumption of morphine at 1,2,4,24and 48h after operation (T3-7)were recorded.The pressing times of analgesia pump,requirement for rescue analgesia and development of nausea and vomiting were recorded at T7.Results There were no significant differences in heart rate or mean arterial pressure at each time point between two groups (P>0.05).Compared with group S,the intensity of pain Was significantly alleviated at T2,and VAS scores and morphine consumption were decreased at T3,4in group P (P<0.05).There were no significant differences between group P and group S in VAS scores or consumption of morphine at T5.7,or pressing times of analgesiapump,requirement for rescue analgesia or incidence of nausea and vomiting at T7(P>0.05).Conclusion Propofol-based anesthesia provides better efficacy in alleviating postoperative acute pain in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy.

关 键 词：二异丙酚 麻醉药 吸入 疼痛 手术后 重症肌无力 胸腔镜检查 胸腺切除术 

分 类 号：R614[医药卫生—麻醉学]