不同时机给药辅助腹腔镜手术的应用  

Application of drug administration at different time points to assist laparoscopic surgery

作　　者：王庆贺 李洪影 WANG Qing-he;LI Hong-ying

机构地区：[1]南阳医学高等专科学校第一附属医院麻醉科,河南南阳473000

出　　处：《中国疗养医学》2024年第7期96-99,共4页Chinese Journal of Convalescent Medicine

基　　金：河南省医学科技攻关项目(1903074)。

摘　　要：目的观察纳布啡不同给药时机辅助腹腔镜手术的应用效果及安全性。方法本研究为前瞻性研究,研究对象从2022年6月至2023年6月南阳医学高等专科学校第一附属医院接受腹腔镜手术治疗的患者中随机抽取106例,按照计算机随机数字表分组,将入组患者分别列为术前组和术后组,各53例。两组患者均实施全身麻醉,术前组在手术开始前30 min采用纳布啡辅助麻醉,术后组于手术结束前30 min采用纳布啡辅助麻醉,比较两组患者的麻醉苏醒情况,苏醒期基础体征,术后镇痛、镇静情况,手术应激情况及麻醉安全性。结果在不同麻醉方法下,术前组的睁眼时间、麻醉恢复室(PACU)停留时间、住院时间均低于术后组;术前组苏醒后1 h、3 h的心率(HR)均高于术后组;平均动脉压(MAP)均高于术后组,差异具有统计学意义(P<0.05);术前组的术后静脉自控镇痛泵(PCIA)应用次数(3.11±0.14)次/d略高于术后组(2.92±0.86)次/d;术前组术后1 h、3 h的视觉模拟疼痛量表(VAS)评分分别为(3.75±0.24)分、(4.23±1.46)分,略高于术后组(3.58±0.72)分、(4.06±1.88)分;Ramsay镇静评分(RSS)分别为(3.55±0.24)分、(3.13±0.32)分,略低于术后组(3.78±0.83)分、(3.26±0.72)分;术前组的去甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)略高于术后组,差异无统计学意义(P>0.05)。术前组的麻醉相关副反应发生率3.77%(2/53)低于术后组20.75%(11/53),差异具有统计学意义(P<0.05)。结论术前30 min予以纳布啡辅助麻醉能缩短腹腔镜手术患者术后苏醒时间,可在不影响术后镇痛、镇静效果或增加手术应激风险同时,有效稳定苏醒期基础体征,并降低麻醉相关副反应发生风险。Objective To observe the application effect and safety of administration of nalbuphine at different time points on assisting laparoscopic surgery.Methods This was a prospective study involving 106 patients who underwent laparoscopic surgery in the First Affiliated Hospital of Nanyang Medical College from June 2022 to June 2023.Patients were randomly assigned into the preoperative group(53 cases)and postoperative group(53 cases)using computer randomization method.General anesthesia was performed in both groups.Patients in the preoperative group received nalbuphine-assisted anesthesia 30 minutes before the surgery,while those in the postoperative group received the same intervention 30 minutes before the end of surgery.The anesthesia recovery,vital signs during the recovery period,postoperative pain and sedation,surgical stress,and anesthesia safety of the two groups were compared.Results Under different anesthesia methods,patients in the preoperative group had significantly shorter eye opening time,postanesthesia care unit(PACU)stay time and hospital stay,significantly higher heart rate(HR)at 1 hour and 3 hours after awakening,and significantly higher mean arterial pressure(MAP)than those of the postoperative group(P<0.05).The application times of patient-controlled intravenous analgesia pump(PCIA)in the preoperative group were slightly higher than those of postoperative group([3.11±0.14]times/day VS[2.92±0.86]times/day).The visual analogue scale(VAS)scores at 1 hour([3.75±0.24]points VS[3.58±0.72]points)and 3 hours postoperatively([4.23±1.46]points VS[4.06±1.88]points)were slightly higher in the preoperative group than those of postoperative group.The Ramsay sedation scale(RSS)scores at 1 hour([3.55±0.24]points VS[3.78±0.83]points)and 3 hours postoperatively([3.13±0.32]points VS[3.26±0.72]points)were slightly lower in the preoperative group than those of postoperative group.The levels of norepinephrine(NE),cortisol(Cor)and angiotensin Ⅱ(Ang Ⅱ)in the preoperative group were slightly higher than those

关 键 词：腹腔镜手术 纳布啡 给药时机 麻醉效果 麻醉安全性 

分 类 号：R614[医药卫生—麻醉学]