七氟醚或丙泊酚维持麻醉对妇科腹腔镜手术患者术后疼痛的影响

Effect of sevoflurane or propofol anesthesia on postoperative pain after gynecological laparoscopic surgery

目的通过观察不同麻醉维持方式下妇科腹腔镜手术患者术后疼痛的情况,比较七氟醚或丙泊酚维持麻醉对患者术后疼痛的影响。方法选择择期行妇科腹腔镜手术女性患者60例,年龄18~65岁,BMI 18~30 kg/m^2,ASAⅠ或Ⅱ级。采用随机数字表法随机分为七氟醚组(S组)和丙泊酚组(P组),每组30例。两组以相同方案麻醉诱导后,S组吸入1.5%~4%七氟醚维持麻醉,P组靶控输注丙泊酚,血浆靶浓度3~6μg/ml。术中维持BIS 40~60。记录术后30 min、1、3、6、24和48 h时患者活动时VAS评分;记录术前1 d、术后3、24和48 h机械性痛阈值;记录术后24 h PCIA按压次数、芬太尼消耗量;记录追加哌替啶的例数和恶心呕吐、寒颤、瘙痒、躁动等不良反应发生情况。结果与术后30 min比较,术后3、6 h两组活动时VAS评分明显升高(P<0.05),术后48 h明显降低(P<0.05)。术后30 min、1和3 h P组活动时VAS评分明显低于S组(P<0.05)。与术前1 d比较,术后3、24和48 h S组机械性痛阈明显降低(P<0.05),术后3 h P组机械性痛阈明显降低(P<0.05)。术后3 h P组机械性痛阈值明显高于S组(P<0.05)。两组PCIA按压次数、芬太尼消耗量、追加哌替啶情况和不良反应发生情况等差异无统计学意义。结论与七氟醚吸入维持麻醉比较,妇科腹腔镜手术中使用丙泊酚静脉维持麻醉可以提高患者术后的机械性痛阈,减轻患者在术后3 h内的疼痛。

Objective To compare the effects of sevoflurane or propofol on postoperative pain by observing the incidence of postoperative pain in patients undergoing gynecological laparoscopic surgery with different anesthesia maintenance methods. Methods Sixty cases of gynecological laparoscopic surgeries, aged 18-65 years, with a BMI 18-30 kg/m^2, falling into ASA physical status Ⅰ-Ⅱ were selected. The patients were randomly divided into two groups according to random number table method: sevoflurane group(group S) and propofol group(group P), each group of 30 cases. Sevoflurane was inhaled 1.5%~4% to maintain anesthesia in group S. In group P anesthesia was maintained with propofol and the plasma concentration of target was set between 3.0-6.0 μg/ml. Two groups were induced with the same anesthesia induction program. BIS was maintained at 40-60 during operation. The motor pain scores(visual analog scale) of patients at 30 min, 1 3, 6, 24 and 48 h after operation were recorded, as well as the mechanical pain threshold 1 day before operation and 3, 24, 48 h after operation. The number of PCIA compressions and fentanyl consumption at 24 h after operation were recored. The pethidine consumption and adverse reactions such as PONV, chills, itching and agitation were recorded. Results Compared with 30 min after operation, VAS scores in the two groups were significantly increased at 3 and 6 h after operation(P < 0.05), and significantly decreased at 48 h after operation(P < 0.05). The VAS score in group P at 30 min, 1 and 3 h after operation was lower than that in group S(P < 0.05). Compared with 1 day before operation, the mechanical pain threshold was significantly reduced in group S at 3, 24 and 48 h after operation(P < 0.05), and significantly decreased in group P at 3 h after operation(P < 0.05). At 3 h after operation, the mechanical pain threshold of group P was significantly higher than that in group S(P < 0.05). There was no significant difference between the two groups in the use of PCIA, fentanyl consumption, pethidine consumption and incidence of the complications. Conclusion Compared with sevoflurane maintenance anesthesia, propofol intravenous maintenance anesthesia in gynecological laparoscopic surgery can improve the mechanical pain threshold and relieve the pain of patients within 3 h after operation.