硫酸镁对腹腔镜胆囊摘除术术后疼痛的影响

The Effect of Magnesium Sulphate on Postoperative Pain After Laparosopic Cholecystectomy

【目的】观察腹腔镜胆囊摘除术的患者应用硫酸镁是否具有围术期镇痛作用。【方法】选择50例择期腹腔镜胆囊摘除术的患者,随机分为两组,每组25例。A组为硫酸镁组,于麻醉诱导时静注硫酸镁40mg/kg,随后以15 mg/(kg.h)的速度持续输注至手术结束;B组为对照组,在麻醉诱导时及麻醉维持阶段未予输注硫酸镁。两组病人术中以5 ml/min的速度持续静脉输注林格液。【结果】在气管插管后1 min、气腹后1 min和气腹后5 min,对照组的SBP、DBP和HR均明显高于硫酸镁组(P均<0.05);在整个手术期间,硫酸镁组和对照组异丙酚的用量恒定,在气管插管后即刻、气管插管后5 min、手术开始时和手术开始后20 min,硫酸镁组所需异氟醚的MAC值较对照组明显降低(P均<0.05);与对照组比较,术后1、2、4、6、8、16和24 h的疼痛VAS评分明显降低(P均<0.05);硫酸镁组在气管插管后5 min、手术结束时和术后第1日的血清镁浓度分别(1.31±0.24)mmol/L,(1.53±0.32)mmol/L和(0.91±0.16)mmol/L,与麻醉前基础水平比较均存在统计学差异(P均<0.05)。【结论】硫酸镁用于腹腔镜胆囊摘除术能减少术中全麻药用量,并具有良好的术后镇痛作用。

[Objective]To investigate the effects of magnesium sulphate on postoperative pain after laparoscopic cholecystectomp（LC）. [Methods]Fifty ASA Ⅰ-Ⅱ patients aged 25-57yr undergoing elective LC were randomized divided into two groups; Group I （magnesium sulphate group） received magnesium sulphate 40 mg/kg before induction, after trachea intubation, magnesium sulphate 15 mg/（kg · h） was infused to the end of surgery. Group Ⅱ （control group）no magnesium sulphate was given in anesthesia induction and maintenance during operation. Ringer＇s solution 5 ml/min was infused continuously in two groups. Anesthesia was maintained with propofol infusion and isoflurance inhalation. [Results]One min after trachea intubation, 1 and 5 min after intra-abdominal insufflation, the SBP ,DBP and HR were significantly higher in control group than in magnesium sulphate group（ P 〈0.05）. During operation,propofol dosage kept constancy in two groups. After intubation,5 min after intubation, at the beginning of surgery, 20 min after beginning of surgery, MAC of Isoflurance in magnesium sulphate group was significantly lower than that in control group（ P 〈0.05）. In two groups comparison, there were significant difference（ P 〈0, 05）. Compared to control group , 1,2,4,6,8,16, 24 h after operation, the scores of VAS were significantly lower in magnesium sulphate group（ P 〈0.05）. In magnesium sulphate group , 5 min after trachea intubation,at the end of surgery,1 day after operation, the serum magnesium concentrations were （ 1.31±0.24 ） mmol/L, （ 1.53 ± 0. 32 ） mmol/L and （0.91 ± 0.16 ） mmol/L respectively, compared with before induction, there were significant difference（ P 〈0.05）. [Conclusion]Intravenous magnesium sulphate in LC can reduce the dosage of general anesthesia drugs and have postoperative analgesia effect.