艾司洛尔对瑞芬太尼在妇科腹腔镜手术中使用剂量的影响

Impact of esmolol on using doses of remifentanil during laparoscopic gynecologic surgery

目的:探讨艾司洛尔对瑞芬太尼在妇科腹腔镜手术中使用剂量的影响。方法:将56例行妇科腹腔镜手术治疗的患者随机分为艾司洛尔组(28例)和生理盐水组(28例),艾司洛尔组予艾司洛尔以0.5 mg·kg-1负荷剂量静脉注入后,再以30μg·kg-1·min-1持续注入;生理盐水组则输入相同剂量的生理盐水。记录所有患者麻醉和手术持续时间。两组间瑞芬太尼前效应室浓度比较采用t检验,瑞芬太尼后效应室浓度比较采用多次方差分析。结果:两组间的瑞芬太尼前效应室浓度差异无统计学意义(P>0.05)。在艾司洛尔组,瑞芬太尼后效应室浓度较前效应室浓度减少33.3%。而艾司洛尔组的瑞芬太尼平均输入速率为(0.09±0.01)μg·kg-1·min-1,低于生理盐水组的(0.14±0.03)μg·kg-1·min-1,两组间差异有统计学意义(P<0.05)。结论:妇科腹腔镜手术中连续输入低剂量的艾司洛尔可以产生类阿片集约效应,减少术中瑞芬太尼的使用量。

Objective： To investigate whether a continuous infusion of low dose esmolol results in an opioid-sparing effect during laparoscopic gynecologic surgery. Methods： 56 patients received the laparoscopic gynecologic surgery in our hospital from September 2011 to May 2012. They were randomly divided into saline group and esmolol group, and their duration of anesthesia and surgery, degreed of pain, total anmount of fentanyl used in PACU and time to discharge from the PACU were recorded. Fisher’s Exact test was used to compare ASA physical status, frequency of postoperative nausea and vomiting （PONV）, and frequency of administered rescue analgesics and anti-emetics. The before effect-site concentration of remifentanil between the two groups was compared by Student’s t-test. The after effect-concentration of remifentanil by infusion of study drugs was analyzed by repeated-measures analysis of variance. Results： The before-concentration of remifentanil was not statistically significantly different between the two groups （P〉0.05）. In the esmolol group, the effect-site concentration of remifentanil was significantly decreased following the esmolol infusion （33.3% decrease, from 2.7 to 1.8 ng/ mL; P〈0.005）. The total dose of remifentanil was also lower in the esmolol group. Conclusions： The esmolol group had qualitatively better results for NRS for the degree of pain and the required amount of rescue analgesic in the PACU.