酮咯酸氨丁三醇复合瑞芬太尼在局麻腰椎孔镜术中的应用

Application of Ketorolac Tromethamine combined with Remifentanil in lumbar endoscopic surgery under local anesthesia

目的观察酮咯酸氨丁三醇复合瑞芬太尼在局麻腰椎孔镜髓核摘除术中的镇痛效果,以及对瑞芬太尼的节俭作用。方法选择本院2014年1月~2015年12月行腰椎孔镜髓核摘除术患者50例,采用随机数字表法将患者分为两组,每组25例:瑞芬太尼辅助局麻组(R组)及酮咯酸氨丁三醇复合瑞芬太尼辅助局麻组(TR组),两组均于术前20 min给药,R组静脉注射5 ml生理盐水,TR组静脉注射30 mg酮咯酸氨丁三醇。局麻前均静脉注射0.25μg/kg瑞芬太尼负荷量后,以0.1μg/(kg·min)的速率输注,期间调整输注速率。术前由术者进行1%利多卡因局部浸润麻醉。术中观察并记录两组患者血压、心率的变化及瑞芬太尼用量,并记录患者低血压、心动过缓、呼吸抑制、恶心呕吐的发生情况。结果 T2~T5各时段,TR组的MAP、HR均较R组更低(P<0.05),T6时段,两组患者的MAP及HR差异无统计学意义(P>0.05)。TR组的瑞芬太尼用量减少,恶心呕吐、呼吸抑制发生率降低(P<0.05);两组患者均未发生明显低血压和心动过缓(P>0.05)。结论酮咯酸氨丁三醇复合瑞芬太尼用于局麻下腰椎孔镜手术可取得较好的镇痛效果,并可有效减少瑞芬太尼使用量,减少术中不良反应的发生。

Objective To observe the analgesic effect of Ketorolac Tromethamine combined with Remifentanil in lumbar endoscopic surgery under local anesthesia,and its frugal role for Remifentanil.Methods Fifty patients received lumbar endoscopic surgery from January 2014 to December 2015 were selected and they were randomly divided into group R（n=25）（Remifentanil assisted by local anesthesia） and group TR（n=25）（Ketorolac Tromethamine combined with Remifentanil assisted by local anesthesia）.Group R was intravenous injected normal saline 5 ml while group TR was intravenous injected Ketorolac Tromethamine 30 mg,they all were given drugs before 20 minutes surgery.Before local anesthesia,Remifentanil were given in the two groups initial dosage of 0.25 μg/kg and then continuous infused in dosage of 0.1μg/（kg·min）,and adjusting the infusion speed.1% lidocaine local anesthesis was given by operator before surgery.During surgery,BP and HR were recorded and the usage amount of Remifentanil was calculated,and the occurrence of low blood pressure,bradyarrhythmia,respiratory depression and nausea vomiting were recorded.Results MAP and HR of group TR were lower compared to group R in the period of T2-T5（P〈0.05）,but the two group has no difference in the period of T6（P〈0.05）.In group TR,the consumption of Remifentanil was less,and the occurrence rate of respiratory depression and nausea vomiting was also reduced（P〈0.05）.Low blood pressure and bradyarrhythmia does not happened in the two groups（P〈0.05）.Conclusion Ketorolac tromethamine combined with Remifentanil may provide better analgesia effect,and can obviously reduce the consumption of Remifentanil and decrease the incidence of adverse reaction during surgery in lumbar endoscopic surgery under local anesthesia.