不同用药方法对脊柱手术患者全麻苏醒质量的影响

Effects of different medications on the recovery quality in patients undergoing spinal surgery under general anesthesia

目的比较帕瑞昔布钠、帕瑞昔布钠联合地佐辛或舒芬太尼静脉注射对脊柱手术患者全麻苏醒质量的影响。方法将择期行腰椎手术的患者60例,分为PD组、PS组、PN组3组,每组20例。于术毕前30 min,每组分别静注帕瑞昔布钠40 mg+地佐辛0.1 mg/kg、帕瑞昔布钠40 mg+舒芬太尼0.1μg/kg、帕瑞昔布钠40 mg+生理盐水5 m L,记录患者自主呼吸恢复时间、意识恢复时间、拔管时间及拔管后的不良反应;记录拔管即刻(T0)、拔管后1 min(T1)、10 min(T2)、30 min(T3)的血流动力学指标、镇静及镇痛评分。结果与PD、PN组比较,PS组自主呼吸恢复时间(8.3±1.5)min和意识恢复时间(9.4±2.1)min均延长,差异有统计学意义(P<0.05);各个时间点PD、PS组镇静评分、镇痛评分均优于PN组,且血流动力学更稳定,但PS组呼吸遗忘和恶心呕吐的发生率明显高于PD组和PN组,差异有统计学意义(P<0.05)。结论术毕前静注帕瑞昔布钠联合地佐辛或舒芬太尼均比单纯静注帕瑞昔布钠镇痛效果好,苏醒质量高,但舒芬太尼导致轻度呼吸遗忘或恶心呕吐的发生率较高。

Objective To compare the effect of intravenous injection of Parecoxib Sodium and Parecoxib Sodium combined with Dezocine or Sufentanil on the recovery period and recovery quality in patients undergoing spinal surgery under general anesthesia.Methods Sixty patients undergoing elective lumbar surgery were randomized into group PD,group PS and group PN（ n = 20）. 30 min before the end of surgery,group PD received intravenous injection of Parecoxib Sodium 40 mg plus 0. 1mg / kg Dezocine,group PS received intravenous injection of Parecoxib Sodium 40 mg plus 0. 1μg / kg Sufentanil and group PN received intravenous injection of Parecoxib Sodium 40 mg plus an equal amount of normal saline（ 5 m L）. Then spontaneous breathing recovery time,consciousness recovery time and extubation time in the three groups were recorded and compared,as well as MAP,HR,SPO2,Ramsay sedation score and visual analogue scale（ VAS） score immediately after extubation（ T0）,1 min after extubation（ T1）,10 min after extubation（ T2） and 30 min after extubation（ T3）,and occurrence of nausea,vomiting,agitation and other adverse reactions. Results Compared with group PD and Group PN,pontaneous breathing recovery time（ 8. 3 ± 1. 5） min and consciousness recovery time（ 9. 4 ± 2. 1） min in group PS were extended,and the differences were statistically significant（ P〈0. 05）; at each time,Ramsay sedation score and VAS score in both group PD and group PS were better than that in group PN,and hemodynamics was more stable. However,the incidences of breathing amnesia and nausea and vomiting in group PS were higher than in group PD and Group PN,and the differences were statistically significant（ P〈0. 05）.Conclusion Intravenousinjection of Parecoxib Sodium and Dezocine or Sufentanil before the end of surgery has better analgesic effect than Parecoxib Sodium alone,and the recovery quality is high,but the incidence of mild Sufentanil- induced breathing amnesia or nausea and vomiting is high.