手术体积描记指数在腹腔镜子宫肌瘤切除术中的应用  

EFFECT OF SURGICAL PLETH INDEX IN PATIENTS UNDERGOING LAPAROSCOPIC MYOMECTOMY WITH TOTAL INTRAVENOUS ANESTHESIA

作　　者：刘佳 鲍宁[1] LIU Jia;BAO Ning(Department of Anesthesiology,Sheny angMaternaland Infant Hospital,Shenyang 110061,China)

机构地区：[1]辽宁省沈阳市妇婴医院,110061

出　　处：《中国煤炭工业医学杂志》2022年第4期369-374,共6页Chinese Journal of Coal Industry Medicine

基　　金：辽宁省自然科学基金(编号:2020-MS-323)。

摘　　要：目的 探讨手术体积描记指数在全凭静脉麻醉腹腔镜子宫肌瘤切除术中的应用。方法 采用前瞻性随机对照研究,择期行腹腔镜子宫肌瘤切除术患者120例,随机分为观察组(S组)和对照组(C组),每组60例。二组均在BIS监测下靶控输注丙泊酚和瑞芬太尼,S组根据手术体积描记指数调节瑞芬太尼用量;C组依据HR、BP调节瑞芬太尼用量。记录术中瑞芬太尼泵注速度、瑞芬太尼总量;记录停药后睁眼及拔管时间、离开PACU时VAS评分;记录术后不良反应如术后呼吸抑制、恶心呕吐、皮肤瘙痒、头晕等。结果 与C组相比,S组患者瑞芬太尼泵注速度、瑞芬太尼总量显著减少,差异有统计学意义(P<0.01);S组换睁眼时间、拔管时间显著缩短,差异有统计学意义(P<0.05);S组患者有3例患者,C组有15例患者术中使用阿托品,差异有统计学意义(P<0.05);二组患者出PACU时静息时及咳嗽时VAS评分差异无统计学意义(P>0.05),皮肤瘙痒、恶心呕吐、头晕等不良反应差异无统计学意义(P>0.05)。结论 手术体积描记指数在靶控输注丙泊酚-瑞芬太尼全麻中可减少术中阿片类药物用量,缩短患者拔管时间,苏醒过程更加平稳,术后苏醒质量更高。Objective To investigate the effect of surgical pleth index on the dosage of remifentanil used in patients undergoing laparoscopic myomectomy with total intravenous anesthesia.Methods A prospective, randomized, single blind, controlled study was conducted.one hundred and twenty patients scheduled for laparoscopic myomectomy were randomly divided into experimental group(Group S) and control group(Group C),60 cases in each group.Propofol-remifentanil were infused by target controlled infusion under BIS monitoring in both groups.Remifentanil dosage was adjusted according to SPI in group S;while it was adjusted according to HR and BP in group C.The dosage of remifentanil and propofol during operation, the time of opening eyes and extubation after drug withdrawal, VAS score when leaving PACU,and the adverse reactions such as postoperative respiratory depression, nausea and vomiting, skin itching, dizziness, etc.were recorded.Results Compared with group C,the dosage of remifentanil, the total amount of remifentanil, the dosage of propofol and the total amount of propofol in group S were significantly reduced, the difference was statistically significant(P<0.01);The time of eye opening and extubation in group S were significantly shortened, the difference was statistically significant(P<0.05);There were 3 patients in group S and 15 patients in group C who used atropine during operation, the difference was statistically significant(P<0.05).There was no significantdifference in VAS score between the two groups at rest and coughing(P>0.05),and there was no significant difference in adverse reactions such as skin itching, nausea and vomiting, dizziness(P>0.05).Conclusion The surgical pleth index in target controlled infusion of propofol-remifentanil general anesthesia can reduce the intraoperative opioid dosage, shorten the extubation time, make the recovery process more stable, and improve the quality of postoperative recovery.

关 键 词：手术体积描记指数 全凭静脉麻醉 腹腔镜子宫肌瘤切除术 瑞芬太尼 

分 类 号：R73[医药卫生—肿瘤]