新斯的明改善腰椎术后胃肠道功能障碍的临床疗效

Clinical observation of neostigmine improves postoperative gastrointestinal dysfunction in patients undergoing lumbar spine surgery

目的探讨新斯的明改善全身麻醉腰椎手术患者术后胃肠道功能障碍的疗效。方法腰椎手术患者60例随机均分为两组,采用静脉复合全身麻醉。麻醉诱导:静脉注射咪达唑仑0.04~0.1mg/kg、丙泊酚1.0~2.0mg/kg、顺式阿曲库铵0.2mg/kg和舒芬太尼0.5~0.6μg/kg。麻醉维持:泵注丙泊酚3~6mg·kg^(-1)·h^(-1),雷米芬太尼6~8μg·kg^(-1)·h^(-1),间断静脉注射顺式阿曲库胺维持肌肉松弛(肌松)。术后气管拔管前,N组静脉注射新斯的明1.0mg和阿托品0.5mg拮抗肌松药残余作用,C组不用新斯的明。术后实施静脉患者自控镇痛(PCA);镇痛药包括舒芬太尼和右美托咪定。记录术后首次肛门排气时间,评估VAS疼痛评分,观察镇痛相关不良反应;检测手术前后血浆胃动素水平。结果两组术后镇痛效果均满意。N组术后首次肛门排气时间早于C组[(14±1)h vs.(26±8)h](P<0.05)。PCA期间,N组恶心呕吐发生率低于C组(6.7%vs.24.0%)(P<0.01),N组术后血浆胃动素水平均高于C组(P<0.01)。结论全身麻醉术毕应用新斯的明拮抗肌松药残余作用,能有效改善全身麻醉腰椎手术患者的术后胃肠道功能障碍。

Objective To observe the efficacy of neostigmine in the improvement of postoperative gastrointestinal dysfunction in the patients undergoing lumbar spine surgery under general anesthesia. Methods Sixty patients were equally randomized into two groups. Anesthesia was induced with midazolam 0. 04-0. 1 mg/kg, propofol 1.0-2.0 mg/kg, cisatracurium 0. 2 mg/kg and sufentanil 0.5-0. 6 μg/kg and maintained with infusions of propofol 3-6 mg. kg^-1 · h^-1 and remifentanil 6-8μg· kg^-1·h^-1, and intermittent intravenous injection of cisatracurium. Before extubation,neostigrnine 1.0 mg and atropine 0.5 mg were injected to antagonize the residual effect of cisatracurium in group N, which was not in group C. The intravenous patient-controlled analgesia （PCA） with sufentanil and dexmedetomidine was performed after operation. The first time for anal exhaust was recorded, VAS pain scores were evaluated and analgesia related adverse reactions were observed during PCA. Plasma motilin was measured before and during PCA. Results Analgesia during PCA was satisfactory in both groups. The first time for anal exhaust was earlier in group N than that in group C[（14±1） h vs. （26±8） h]（P〈0. 05）. The incidence of nausea and vomiting was less in group N than that in group C（6.7% vs. 24.0%） （P〈0. 01）. Plasma levels of motilin were higher in group N than those in group C（P〈0. 01）. Conclusion Neostigmine used for antagonizing the residual effect of muscular relaxant can improve postoperative gastrointestinal dysfunction in the patients undergoing lumbar spine surgery under general anesthesia.