腹腔镜全凭静脉麻醉复合罗哌卡因的镇痛效果及对全麻苏醒的影响

A Study on the Postoperative Analgesia of Total Intravenous Anesthesia under Laparoscopic Surgery Combined with Ropivacaine and Its Influence on the Recovery for General Anesthesia

目的:探讨腹腔镜全凭静脉麻醉复合罗哌卡因的镇痛效果及对全麻苏醒的影响。方法:将70例妇产科腹腔镜手术患者随机分为治疗组与对照组,对照组全凭静脉丙泊酚麻醉,治疗组在此基础上复合0.375罗哌卡因硬膜外麻醉。比较两组术后镇痛效果、麻醉药物用量、不良反应的发生情况、术后呼吸恢复时间、苏醒时间、拔管时间、苏醒后躁动的发生率及躁动程度。结果:治疗组术后2、12、24 h切口疼痛的VAS评分均较对照组明显降低(P<0.05);与对照组比较,治疗组术中丙泊酚、瑞芬太尼用量明显减少,术后呼吸恢复时间、苏醒时间及拔管时间明显缩短(P<0.05),苏醒后躁动的发生率及躁动程度均较对照组明显降低(P<0.05)。两组均无明显不良反应发生。结论:全凭静脉麻醉复合罗哌卡因硬膜外麻醉对腹腔镜手术可产生良好的镇痛、镇静效果,减少术后疼痛和全麻药剂量,促进早期苏醒。

Objective： To explore the postoperative analgesia of total intravenous anesthesia （TIVA） under laparoscopic surgery combined with ropivacaine and its influence on recovery for general anesthesia. Methods： 70 patients for laparoscopic surgery in the department ofgynaecology and obstetrics were randomly divided into two groups including treatment group（n=35）, control group （n=35）. The control group was performed by TIVA with propofol, and the treatment group was given 0.375% ropivacaine forepidural anesthesia additionally. The postoperative analgesia effect, dosage of anesthetic drugs, occurrence of adverse reactions, postoperative respiratory recovery time, waking time, extubation time, incidence of agitation after waking up and degree of agitation were compared between two groups. Results： The VAS scores at 2h, 12h, 24h after laparoscopic surgery of treatment group were significantly lower than those of the control group （P〈0.05）. Compared with the control group, the intraoperative dosage ofpropofol and fentanyl was significantly decreased in the treatment group, the postoperative respiratory recovery time, recovery time and extubation time were significantly shortened （P〈0. 05）. The incidence of agitation after waking up and degree of agitation were significantly decreased in the treatment group than those of the control group （P〈0.05）. No obvious adverse reactions was found in both groups. Conclusions： TIVA combined with ropivacaine could produce good analgesic and sedative effect, reduce postoperative pain and general anesthetics dose, promote early awakening for the elderly patients undergoing laparoscopic surgery.