瑞芬太尼在腹腔镜胆囊切除术后的镇痛效果评价  

Analgesic Effect of Remifentanil in Patients with Laparoscopic Cholecystectomy

作　　者：李亮星[1] 王海[1] 祝正中 LI Liangxing;WANG Hai;ZHU Zhengzhong(Department of Emergency,Shougang Hospital Affiliated to Peking University,Beijing 100044,China)

机构地区：[1]北京大学首钢医院急诊科,北京100044

出　　处：《医学综述》2018年第21期4360-4364,共5页Medical Recapitulate

摘　　要：目的评价瑞芬太尼应用于腹腔镜下胆囊切除术患者的镇痛效果。方法选择2016年11月至2017年12月在北京大学首钢医院接受腹腔镜下胆囊切除术的患者96例,按照随机数字法分为研究组和对照组各48例,研究组先后采用瑞芬太尼0. 2 g/(kg·min)和0. 005~0. 01 g/(kg·min)术中、术后镇痛;对照组先后采用芬太尼0. 03 g/(kg·min)和0. 01~0. 02 g/(kg·min)进行术中和术后镇痛。观察两组患者手术前后的平均动脉压(MAP)、心率、动脉血氧饱和度(Sa O2);术后不同时相点的视觉模拟评分法(VAS)、Ramsay评分、C反应蛋白(CRP)、皮质醇,记录患者术后不良反应发生率。结果对照组气腹后、拔管前MAP、心率水平均较诱导前逐渐升高,研究组MAP先升高后降低,心率水平逐渐降低,两组在组间、时点间、组间·时点间交互作用比较差异有统计学意义(P <0. 05)。两组Sa O2在组间、时点间、组间·时点间交互作用比较差异无统计学意义(P> 0. 05)。两组术后6 h、术后12 h血清CRP、皮质醇水平较麻醉前明显升高,且对照组上升速度更快,两组在组间、时点间、组间·时点间交互作用比较差异有统计学意义(P <0. 01)。两组术后4 h、8 h、12 h的VAS评分、Ramsay评分均逐渐降低,且研究组VAS、Ramsay评分下降速度更快,两组在组间、时点间、组间·时点间交互作用比较差异有统计学意义(P <0. 01)。研究组患者术后总不良反应发生率显著低于对照组[8. 33%(4/48)比27. 08%(13/48)](P <0. 05),主要表现为呼吸抑制、恶心呕吐、心动过缓。结论腹腔镜下胆囊切除术患者采用瑞芬太尼持续静脉输注,可有效减轻术中、术后的应激反应,同时镇痛、镇静效果满意,不良反应少。Objective To investigate the effect of remifentanil on analgesia and stress in patients with laparoscopic cholecystectomy. Methods A total of 96 patients with laparoscopic cholecystectomy from Shougang Hospital Affiliated to Peking University during Nov. 2016 and Dec. 2017 were included in the study,and divided into an observation group and a control group according to the random number method.The observation group was given reminfentanil 0.2 g/（kg·min） and 0.005-0.01 g/（kg·min） during and after operation;the control group was given fentanyl 0.03 g/（kg·min） and 0.01 -0.02 g/（kg·min）during and after operation.Mean arterial pressure（MAP）,heart rate and arterial oxygen saturation（SaO 2） were compared between the two groups before and after operation.Visual analogue scale（VAS）,Ramsay sedation scale,C-reactive protein and cortisol at different time points after operation,as well as adverse reactions were analyzed. Results After pneumoperitoneum and before extubation,the MAP and heart rate increased gradually in the control group but increased followed decrease in the observation group,and the differences between groups,time points and group· time interaction were statistically significant（ P 〈0.05）.However,the differences of SaO 2 between groups,time points and group· time interaction were insignificant（ P 〉0.05）.At 6 h and 12 h postoperatively, serum content of Cortisol and CRP in both groups increased than before anaesthesia and increased more rapidly in the observation group than in the control group,presenting between groups,time points and group· time interaction（ P 〈0.01）.At 4 h,8 h and 12 h postopera- tively ,the VAS and Ramsay score decreased in both groups but declined more rapidly in the observation group,presenting significant differences between groups,time points and group· time interaction（ P 〈0.01）.The observation group had much fewer adverse reactions than the control group[8.33%（4/48） vs 27.08%（13/48）]（ P 〈0.05）, which incl

关 键 词：腹腔镜胆囊切除术 瑞芬太尼 镇痛 

分 类 号：R614[医药卫生—麻醉学]