无阿片类药物麻醉在非插管胸腔镜手术中的应用  

Application of opioid-free anesthesia in non-intubated thoracoscopic surgery

作　　者：刘克[1] 叶文学 郑观荣[1] 王大龙[1] 张帅帅[1] 刘新泽 王宁 Ke Liu;Wen-xue Ye;Guan-rong Zheng;Da-longWang;Shuai-shuai Zhang;Xin-ze Liu;NingWang(Department of Anesthesiology,Shengli Oilfield Central Hospital,Dongying,Shandong 257034,China;Department of Medical Administration,Shengli Oilfield Central Hospital,Dongying,Shandong 257034,China;Department of Thoracic Surgery,Shengli Oilfield Central Hospital,Dongying,Shandong 257034,China)

机构地区：[1]胜利油田中心医院麻醉科,山东东营257034 [2]胜利油田中心医院医务部,山东东营257034 [3]胜利油田中心医院胸外科,山东东营257034

出　　处：《中国现代医学杂志》2021年第17期46-51,共6页China Journal of Modern Medicine

摘　　要：目的评价无阿片类药物麻醉在非插管胸腔镜手术中的安全性和可行性。方法选取2019年5月—2019年11月在胜利油田中心医院行胸腔镜下单侧肺叶切除术(肺叶、肺段楔形)患者60例作为研究对象。采用随机数字表法分为无阿片麻醉组和对照组,每组30例。无阿片麻醉组采取无阿片类药物麻醉诱导后置入喉罩保留自主呼吸,对照组行传统全身麻醉双腔气管插管。记录两组患者的麻醉满意度、手术视野暴露满意度、手术时间、苏醒时间、拔管(喉罩)时间、术毕主动下床活动时间和出院时间;记录术中及术后24 h内不良反应发生例数。结果两组的麻醉效果、手术视野暴露满意度比较,差异无统计学意义(P>0.05);两组术后苏醒时间、拔管时间、术毕下床活动时间和出院时间比较,无阿片麻醉组少于对照组(P<0.05);两组术中呛咳、低氧血症、二氧化碳蓄积发生例数比较,差异无统计学意义(P>0.05)。术中心血管不良事件无阿片麻醉组7例,对照组21例,两组比较,差异有统计学意义(P<0.05);两组术后呼吸抑制、躁动、头晕、皮肤瘙痒患者比较,无阿片麻醉组少于对照组(P<0.05);两组术后24 h内恶心、呕吐比较,差异无统计学意义(P>0.05),但术后6 h内无阿片麻醉组恶心和呕吐的发生少于对照组(P<0.05)。结论无阿片类药物麻醉应用于非插管胸腔镜手术安全可行,可减少术后不良反应,有利于患者的快速康复。Objective To evaluate the feasibility and safety of opioid-free anesthesia in non-intubated thoracoscopy surgery.Methods Sixty patients undergoing thoracoscopic,aged 50 to 70 years,with body mass index of 20 to 24 kg/m2,of American Society of Anesthesiologists physical status(ASA)I or II,scheduled for thoracoscopy surgery under general anesthesia,were randomly divided into either opioid-free anesthesia group or control group with a random number table,30 patients in each group.In opioid-free anesthesia group,laryngeal mask was placed after opioid-free anesthesia vein induction and muscle relaxant was not used during the operation.In control group,conventional double-lumen endobronchial catheters were used to achieve single-lung ventilation during surgery.Side effects,such as intraoperative choke to cough,hypoxemia,carbon dioxide accumulation,hypertension,hypotension,tachycardia,bradycardia,were recorded.The anesthesia satisfaction score,operative field exposure score,operation time,recovery time,extubation time,post-operation activity time after operation,and postoperative hospital stay were recorded.Adverse reactions with 24 h were recorded.Results There was no statistically significant difference between the two groups in terms of anesthetic effect and degree of satisfaction with surgical field exposure(P>0.05).However,there was a statistically significant difference between the two groups in terms of postoperative recovery time,extubation time,post-operation activity time,and discharge time(P<0.05).There was no significant difference in the incidence of cough,hypoxemia,and carbon dioxide accumulation between the two groups(P>0.05).There were 7 cases of adverse events in opioid-free anesthesia group and 21 cases in control group,comparison between groups was statistically significant difference(P<0.05).Postoperative respiratory depression,agitation,itchy skin,and dizziness appeared in opioid-free anesthesia group was obviously less than the control group,the difference was statistically significant(P<0.05).Ther

关 键 词：全身麻醉 无阿片类麻醉药物 非气管插管 胸腔镜 

分 类 号：R614[医药卫生—麻醉学]