氟比洛芬酯联合地佐辛对腹腔镜下食管裂孔疝修补术后拔管期患者血流动力学影响

Effect of preemptive analgesia with flurbiprofen axetil combined with dezocine on hemodynamics during tracheal extubation after laparoscopic of hernia-hiata patients

目的探讨氟比洛芬酯联合地佐辛超前镇痛对腹腔镜下食管裂孔疝修补术后拔管期患者血流动力学的影响。方法选取新疆维吾尔自治区人民医院2017年1至12月腹腔镜下食管裂孔疝修补术患者60例,ASAⅠ-Ⅱ级,随机分为氟比洛芬酯联合地佐辛(DF组)、氟比洛芬酯组(F组)和地佐辛组(D组),每组患者均20例。患者均全身麻醉,麻醉诱导前15 min,DF组静脉给予地佐辛0.1 mg/kg和氟比洛芬酯1 mg/kg;D组静脉给予地佐辛0.1 mg/kg;F组静脉给予氟比洛芬酯1 mg/kg。分别记录手术前(基础值,T0)、缝皮结束时(T1)、拔管即刻(T2)、拔管后5 min(T3)、10 min(T4)的MAP、HR及术后自主呼吸恢复时间、睁眼时间、拔管时间及拔管期不良反应发生情况。结果 3组患者年龄、体重指数、手术时间、拔管时效、不良反应等一般资料比较,差异无统计学意义(P>0.05);3组患者在术前及拔管后10 min的MAP、HR比较,差异均无统计学意义(P>0.05);与DF组比较,D组T2和T3时刻MAP、HR明显升高,差异均有统计学意义(P<0.05);F组T1-T3时刻MAP、HR明显升高,与DF组差异均有统计学意义(P<0.05)。结论氟比洛芬酯联合地佐辛超前镇痛能有效抑制腹腔镜下食管裂孔疝修补术患者拔管期的血流动力学波动,提高患者的苏醒质量,优于单一用药。

Objective To investigate the effect of preemptive analgesia with flurbiprofen axetil combined with dezocine on hemodynamics during tracheal extubation after laparoscopic of Hernia-hiata patients. Methods 60 cases of obese patients undergoing laparoscopic cholecystectomy, ASA I-II, were randomly divided into group of flurbiprofen axetil combined with dezocine (group DF), flurbiprofen axetil group (group F) and dezocine group (group D). All patients underwent general anesthesia. In the 15 minutes before anesthesia induction, the group DF was given 0.08 mg/kg of dezocine and 0.6mg/kg of flurbiprofen axetil, group D was given 0.1mg/kg of dezocine and group F was given 1 mg/kg of flurbiprofen axetil from the vein. MAP and HR values were recorded respectively before operation (baseline, T0), at the end of the seam (T1), at the time of extubation (T2), 5min after extubation (T3) and 10min after extubation (T4). At the same time, the time of spontaneous breathing recovery, the time of eye opening, the time of extubation and the adverse reactions during extubation were recorded. Results There were no significant differences among the three groups in terms of age, body mass index, operation time, extubation time and adverse reactions (P>0.05). There were no significant differences among the three groups in the MAP and HR values before operation and 10min after the extubation (P>0.05). Compared with group DF, the MAP and HR values of T2 and T3 in group D were increased significantly (P<0.05), and the MAP and HR values of T1- T3 in group F were increased significantly (P<0.05). Conclusion Preemptive analgesia with flurbiprofen axetil combined with dezocine can effectively inhibit hemodynamic fluctuations of the obese patients during extubation period and improve the recovery quality of patients with obesity. It is superior to that of single agent.