摘要
目的探讨腹腔镜卵巢囊肿剥除术中应用意识指数(index of consciousness,IoC)2指导术中镇痛药物使用对患者的影响。方法选择拟择期实施腹腔镜卵巢囊肿剥除术的患者102例,ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为对照组(C组)和试验组(T组)。两组患者均使用丙泊酚、瑞芬太尼诱导和维持麻醉,并使用IoC1(40~60)监测镇静,C组患者麻醉中根据麻醉医师的经验调整瑞芬太尼用量,T组则根据IoC2值(30~50)调整瑞芬太尼输注速度。术中根据患者循环情况使用阿托品和血管活性药维持循环稳定。记录两组患者麻醉前、手术前、手术开始1 min、手术开始30 min、手术结束和拔管后5 min时的MAP、心率,同时记录血压和心率波动幅度超过基础值20%的次数;记录手术时间、术中出血量和输液量、手术结束至拔管时间及围手术期丙泊酚、瑞芬太尼、麻黄碱、阿托品、乌拉地尔及艾司洛尔用量;记录拔管后、PACU期间、术后1 d的数字分级评分法(numerical rating scale,NRS)评分和术前、术毕的血糖情况。结果两组患者的一般资料及手术资料比较差异无统计学意义(P>0.05);与麻醉前比较,各时点MAP、心率差异均有统计学意义(P<0.05);手术开始1 min、手术开始30 min、手术结束和拔管后5 min C组MAP、心率明显高于T组(P<0.05);C组心动过缓发生率低于T组(P<0.05),高血压发生率高于T组(P<0.05)。与C组比较,T组术中瑞芬太尼、阿托品用量增加(P<0.05),乌拉地尔用量明显降低(P<0.05)。拔管后和术后1 d,T组NRS评分较C组低(P<0.05)。术毕时T组血糖低于C组(P<0.05)。其他指标差异无统计学意义。结论腹腔镜卵巢囊肿剥除术中应用IoC2指导镇痛管理,血流动力学更平稳、血糖波动较小、术后疼痛的发生率降低。
Objective To investigate the effect of using the index of consciousness(IoC)2 to guide the use of intraoperative analgesic drugs on patients during laparoscopic ovarian cyst exfoliation.Methods A total of 102 American Society of Anesthesiologists(ASA)ⅠorⅡlevel patients undergoing elective laparoscopic ovarian cyst exfoliation were randomly divided into control group(group C)and experimental group(group T)by the random number table method.Induction and maintenance of anesthesia were continually pumping propofol and remifentanil,and sedation was guided by the value of IoC1(40-60).Remifentanil dosage in group C was adjusted based on the anesthesiologist's experience;in group T,the dose of remifentanil was adjusted according to IoC2(30-50).Intraoperatively,atropine and vasoactive drugs were used to maintain circulation stability.Mean arterial pressure(MAP)and heart rate were recorded before anesthesia,1 min after an operation,30 min after the operation,in the end,and 5 min after extubation.The frequency of blood pressure and heart rate fluctuations exceeding 20%of the basal value was also recorded.The operation time,intraoperative blood loss and infusion volume,the time from the end of operation to extubation,and the perioperative dosage of propofol,remifentanil,ephedrine,atropine,urapidil,and esmolol were recorded.The Numerical Rating Scale(NRS)scores after extubation,during post-anesthesia care unit(PACU),and on a postoperative day 1 were recorded,and the blood glucose levels after entering the room and at the end of the operation were recorded.Results The results showed no statistically significant difference between the two groups was found in the general and surgical data(P>0.05).Compared with before anesthesia,there were significant differences in MAP and heart rate at each time point(P<0.05).MAP and heart rate in group C were significantly higher than in group T at 1 min,30 min,end of the operation,and 5 min after extubation(P<0.05).The incidence of bradycardia in group C was lower than that in group T(P<0
作者
魏晶晶
肖玮
阚敏慧
王盼雨
王天龙
Wei Jingjing;Xiao Wei;Kan Minhui;Wang Panyu;Wang Tianlong(Department of Anesthesiology,Xuanwu Hospital,Capital Medical University;Beijing Municipal Geriatric Medical Research Center,Beijing 100053,China)
出处
《国际麻醉学与复苏杂志》
CAS
2022年第9期933-939,共7页
International Journal of Anesthesiology and Resuscitation
基金
中国医师协会麻醉学医师分会青年麻醉医师科研基金(21900009)
北京市医院管理局"培育计划"(PX2019031)。
关键词
腹腔镜手术
卵巢囊肿剥除术
意识指数
血流动力学
术后疼痛
Operative laparoscopy
Ovarian cyst exfoliation
Index of consciousness 2
Haemodynamics
Postoperative pain
