麻醉深度对腹腔镜胆囊切除术后疼痛的影响

Effect of depth of anesthesia on postoperative pain after laparoscopic cholecystectomy

目的探讨麻醉深度对腹腔镜胆囊切除术后疼痛的影响。方法选取九江市第一人民医院行腹腔镜下胆囊切除术患者60 例,随机分为低脑电双频指数(L-BIS=35 ~ 44)组和高脑电双频指数(H-BIS=45~ 55)组。两组患者施行相同的静脉全身麻醉,并通过调节脑电双频指数(BIS)将麻醉深度控制在不同水平,观察并记录患者苏醒时(0 h)和术后8、16 和24 h 的VAS 评分、术后24 h 内额外镇痛药的使用情况、恶心呕吐情况及镇痛满意度评分情况。结果 L-BIS 组患者在静息和咳嗽时的VAS 评分低于H-BIS 组。H-BIS 组恢复期间需要额外镇痛药的患者多于L-BIS 组(P <0.05)。L-BIS 组术后24 h 恶心呕吐发生率低于H-BIS 组(P <0.05);L-BIS 组术后镇痛满意度评分高于H-BIS 组(P <0.05)。结论全身麻醉中维持L-BIS 较H-BIS对术后额外镇痛药的需求减少,恶心呕吐发生率减少,患者满意度提高。

Objective To investigate the effect of depth of anesthesia on postoperative pain after laparoscopic cholecystectomy. Methods Sixty patients undergoing laparoscopic cholecystectomy were randomly divided into two groups: low bispectral index group (L-BIS = 35 to 44) and high bispectral index group (H-BIS = 45 to 55), anesthesia induction and maintenance protocol was the same for both groups, and the depths of anesthesia was controlled in different levels. We evaluated VAS score (at rest and during cough) at recovery (0), 8th, 16 and 24th hours after operation and recorded the mean dose of using remedial analgesic within 24 hours, the condition of post-operative nausea and vomiting (PONV), the condition of patients’ satisfaction. Results The VAS scores of patients in the L-BIS group at rest and cough were lower than those in the H-BIS group. The number of patients requiring additional analgesics during recovery in the H-BIS group was greater than in the L-BIS group (P < 0.05). The incidence of nausea and vomiting in the L-BIS group was lower than that in the H-BIS group at 24 h after operation (P < 0.05). The postoperative analgesia satisfaction in the L-BIS group was higher than that in the H-BIS group (P < 0.05). Conclusions General anesthesia with propofol and remifentanil with L-BIS causes less need for additional analgesic drug, less nausea and vomiting and higher postoperative analgesia satisfaction of the patients compared to anesthesia with H-BIS.