腹腔镜胆囊切除术患者不同剂量舒芬太尼对术后恢复质量的影响

Effect of different doses of sufentanil on postoperative recovery quality in patients undergoing laparoscopic cholecystectomy

①目的观察腹腔镜胆囊切除术患者不同剂量舒芬太尼对术后恢复质量的影响。②方法选择择期腹腔镜胆囊切除术患者80例,随机分为4组(每组20例):等容量0.9%氯化钠组(对照组,Ⅰ组)、舒芬太尼0.1μg/kg(Ⅱa组)、0.2μg/kg(Ⅱb组)、0.3μg/kg(ⅡC组),所有患者采用靶控输注丙泊酚、瑞芬太尼和阿曲库按的麻醉方法,常规监测心电图、血压、心率、脉搏血氧饱和度、呼气末二氧化碳分压和脑电双频谱指数。在手术结束前10min分别于Ⅰ组、Ⅱa、b、c组静注等剂量的0.9%氯化钠和舒芬太尼0.1、0.3、0.5μg/kg。记录手术结束后患者自主呼吸恢复时间、苏醒时间和拔管时间,以及拔管后10min的视觉模拟疼痛评分(VAS评分)、舒适度评分(BCS评分)、镇静度(Ramsay)评分。③结果与Ⅰ组相比,Ⅱa和Ⅱb组的呼吸恢复时间、苏醒时间和拔管时间没有明显变化(P>0.05),但Ⅱc组的上述指标明显延长(P<0.05);Ⅱ(a,b,c)组的VAS评分、BCS评分和Ramsay评分差异有统计学意义(P<0.05)。④结论丙泊酚复合瑞芬太尼静脉麻醉下行腹腔镜胆囊切除手术结束前10min给予舒芬太尼0.2μg/kg可有效地缓解急性疼痛,对自主呼吸恢复和意识恢复没有明显影响。

Objective To study effect of different doses of sufentanil on postoperative recovery quality in patients undergoing laparoscopic cholecystectomy （LC） in remifentanil - based anesthesia with propofol. Methods 80 ASA Ⅰ or Ⅱ grade patients un-dergoing LC were randomly divided into 4 groups ： control group （ Ⅰ group, NS） and sufentanil 0.1 μg/kg group （ Ⅱa group） ,0.2μg/ kg group（ Ⅱb group） and 0.3μg/kg group（ Ⅱ c group） （n = 20, in each group）. ECG,BP,HR,PETCO2 and Bis were monitored during operation. Anesthesia was induced and maintained with propofol and remifentanil by TCI in all patients, which received intra-venous instillation of 2mL NS and sufentanil （1 μg/kg, 2μg/kg and 3 μg/kg）10 min before the end of the operation respectively. Propofol and remifentanil was switched off 10 min before the end of surgery. Time of spontaneous respiraory resumption ,eye opening time and extubation time were measured, VAS,BCS and Ramsay scale were evaluated. Results Compared with I group,there were no significant differences in the time of spontaneous respiratory resumption, eye opening time and extubation time between I group to Ⅱb group（ P 〉 0.05 ） , but above targets in Ⅱ c group lengthen obviously（ P 〈 0.05 ） , there were significant differences in VAS, BCS and Ramsay scale between Ⅱ a to Ⅱ c groups （ P 〈 0.05 ）. Conclusion Administration of sufentanil （0.2 μg/kg） 10 min be-fore the end of LC can effectively provide pain relief, there was no obvious effects on time of spontaneous respiratory resumption, eye opening and extubation.