艾司氯胺酮对瑞芬太尼麻醉鼻窦手术患者术后疼痛及苏醒的影响  

The effects of etomidate combined with remifentanil on postoperative pain and recovery quality in patients undergoing nasal sinus surgery

作　　者：郑少卿 陈小淑 邓玉萍[1] 黄焕森[1] ZHENG Shao-qing;CHEN Xiao-shu;DENG Yu-ping;HUANG Huan-sen(Department of Anesthesiology,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510220,Guangdong,China)

机构地区：[1]广州医科大学附属第二医院麻醉科,广东广州510220

出　　处：《广东医学》2024年第4期458-462,共5页Guangdong Medical Journal

摘　　要：目的探讨艾司氯胺酮联合麻醉诱导对瑞芬太尼麻醉鼻窦手术患者术后疼痛及苏醒质量的影响。方法择期行鼻内镜鼻窦手术患者90例,ASAⅠ~Ⅱ级,按随机数字表法分为3组,每组30例。分别予瑞芬太尼(R组)、瑞芬太尼+0.25 mg/kg艾司氯胺酮(RA1组)以及瑞芬太尼+0.5 mg/kg艾司氯胺酮(RA2组),3组患者术中持续输注瑞芬太尼、丙泊酚维持麻醉。记录患者的一般情况,术后30 min及1、2、6、12、24 h的VAS评分,麻醉前(T0)和诱导后(T1)的平均动脉压(MAP)和心率(HR),拔管时间、拔管时Ramsay评分,术后24 h内曲马多镇痛例数,以及术后呕吐、头晕、精神症状等不良反应发生率。结果RA1组、RA2组术后30 min及1、2、6 h的VAS评分明显低于R组(P<0.05);与R组比较,RA1组、RA2组诱导后(T1)的MAP、HR增高;3组患者拔管时间差异无统计学意义(P>0.05);术后24 h内RA1组及RA2组曲马多镇痛例数减少(P<0.05)。RA2组患者拔管时Ramsay评分1分例数明显多于R组和RA1组(P<0.05);RA1组和RA2组术后头晕、精神症状发生率高于R组(P<0.05),其中RA2组精神症状发生率高于RA1组;3组术后恶心呕吐、寒颤、呼吸抑制发生率差异无统计学意义(P>0.05)。结论艾司氯胺酮联合麻醉诱导有利于诱导期循环稳定,减轻麻醉术后疼痛,预防大剂量瑞芬太尼痛觉过敏,不影响术后苏醒,且0.25 mg/kg较0.5 mg/kg患者术后不良反应的发生率低。Objective To investigate the effects of etomidate combined with anesthesia induction on postoperative pain and recovery quality in patients undergoing nasal sinus surgery under remifentanil anesthesia.Methods Ninety patients scheduled for nasal endoscopic sinus surgery with ASA physical statusⅠ-Ⅱwere randomly divided into three groups(n=30 per group):remifentanil(R group),remifentanil plus 0.25 mg/kg etomidate(RA1 group),and remifentanil plus 0.5 mg/kg etomidate(RA2 group).All patients received continuous infusion of remifentanil and propofol for anesthesia maintenance.General patient information,visual analog scale(VAS)scores at 30 minutes,1 hour,2 hours,6 hours,12 hours,and 24 hours postoperatively,mean arterial pressure(MAP)and heart rate(HR)at induction(T0)and post-induction(T1),extubation time,Ramsay sedation scale score at extubation,tramadol consumption within 24 hours postoperatively,and incidence of postoperative adverse reactions such as nausea,dizziness,and mental symptoms were recorded.Results VAS scores at 30 minutes,1 hour,2 hours,and 6 hours postoperatively were significantly lower in the RA1 and RA2 groups compared to the R group(P<0.05).MAP and HR at T1 were higher in the RA1 and RA2 groups than in the R group.There was no significant difference in extubation time among the three groups(P>0.05).The number of patients requiring tramadol within 24 hours postoperatively was lower in the RA1 and RA2 groups(P<0.05).The RA2 group had significantly more patients with a Ramsay sedation scale score of 1 at extubation compared to the R and RA1 groups(P<0.05).The incidence of dizziness and mental symptoms postoperatively was higher in the RA1 and RA2 groups compared to the R group(P<0.05),with a higher incidence in the RA2 group than in the RA1 group.There was no significant difference in the incidence of nausea,vomiting,shivering,or respiratory depression among the three groups(P>0.05).Conclusion Etomidate combined with anesthesia induction contributes to hemodynamic stability during induction,alleviat

关 键 词：艾司氯胺酮 瑞芬太尼 鼻内镜鼻窦手术 术后痛觉 

分 类 号：R614[医药卫生—麻醉学] R765[医药卫生—外科学]