多模式镇痛对妇科腹腔镜手术芬太尼用量及血流动力学的影响  

THE EFFECT OF MULTIMODAL ANALGESIA ON FENTANYL CONSUMPTION AND HEMODYNAMICS IN GYNECOLOGICAL LAPAROSCOPY

作　　者：耿倩 李旭[1] 何凯[1] 申乐[1] 黄宇光[1] GENG Qian LI Xu HE Kai SHEN Le HUANG Yu-Guang(Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730 [2]首都医科大学三博脑科医院麻醉科,北京100093

出　　处：《中国疼痛医学杂志》2017年第9期673-677,共5页Chinese Journal of Pain Medicine

摘　　要：目的:通过比较多模式镇痛全身麻醉与传统模式镇痛全身麻醉,明确多模式镇痛对妇科腹腔镜术中芬太尼用量及血流动力学的影响。方法:回顾分析北京协和医院2016年9月至12月因为妇科良性疾病接受腹腔镜手术治疗的病人100例,其中33例(多模式镇痛组,M组)全身麻醉采用了联合应用芬太尼、瑞芬太尼、非甾体抗炎药(non-steroidal antiinflammatory drugs,NSAIDs)及持续静脉输注利多卡因(continuous intravenous injection of lidocaine,IVIL)等药物的多模式镇痛(multimodal analgesia,MMA)方案,67例(对照组,C组)全身麻醉采用芬太尼单一镇痛药物的传统模式镇痛方案。比较两组的芬太尼用量以及病人入室时(T_0)、麻醉诱导后即刻(T_1)、手术开始即刻(T_2)、手术结束即刻(T_3)、拔管后即刻(T_4)的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)值。结果:与C组比较,M组病人术中芬太尼用量明显减少(P<0.05),M组T_2~T_4的SBP和HR,T_2和T_4的MAP,T_4的DBP均显著降低(P<0.05);与T_0比较,M组T_1时SBP、DBP、MAP显著降低(P<0.05),随后无统计学差异;C组T_1时SBP、DBP、MAP显著降低(P<0.05),T_2和T_4的SBP和MBP、T_3的DBP及T_2~T_4的HR显著升高(P<0.05)。结论:对于妇科腹腔镜手术病人,术中采用联合应用芬太尼、瑞芬太尼、非甾体抗炎药及持续静脉输注利多卡因等药物的多模式镇痛可以减少术中芬太尼用量并有利于维持术中血流动力学的稳定。Objective：To investigate the effect of multimodal analgesia on the dosage of fentanyl and hemodynamics in gynecological laparoscopy by comparing the multimodal analgesic general anesthesia with the traditional model of analgesic general anesthesia.Methods： A total number of 100 patients from September to December 2016, who were admitted into Peking Union College Hospital for elective gynecological laparoscopic surgery. Among them, 33 patients were infused with fentanyl, remifentanyl, non-steroidal antiinflammatory drugs, and continuous intravenous injection of lidocaine. The other 67 patients were only infused with fentanyl. The levels of systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP） and heart rate （HR） were recorded when the patient entered the room （T0）, immediately after inducing general anesthesia （T1）, immediately when surgery began （T2）, and immediately after surgery （T3）, immediately after extubation （T4）. The fentanyl dosage, preoperative and postoperative body temperature, operation time,anesthesia time, recovery time, hospital days and so on were also recorded.Results： Compared with group C, the dosage of fentanyl in group M was significantly decreased （P〈 0.05）, the levels of SBP and HR at T2to T4, the MAP at T2 and T4, and the DBP at T4 in group M were significantly decreased （P〈 0.05）. Compared with T0, SBP, DBP and MAP at T1 were significantly decreased in group M （P〈 0.05）, then there was no difference. In group C, compared with T0, the SBP、DBP and MAP at T1 were significantly decreased （P〈 0.05）, the SBP and MBP at T2 and T4, the DBP at T3 and the HR at T2 to T4 were significantly increased （P〈 0.05）. Conclusion：Multimodal analgesia is helpful to reducing intraoperative fentanyl consumption and maintaining hemodynamic stability.

关 键 词：多模式镇痛 腹腔镜手术 芬太尼 血流动力学 

分 类 号：R614[医药卫生—麻醉学]