无阿片类药物全麻联合硬膜外麻醉在腹腔镜胆囊切除术中的麻醉效果

Anesthetic Effect of Opioid-Free Anesthesia Combined with Epidural Anesthesia in Laparoscopic Cholecystectomy

目的 探讨无阿片类药物全麻联合硬膜外麻醉在腹腔胆囊切除术中的麻醉效果。方法 选取2021年1月至2023年1月在安阳市第二人民医院治疗需行腹腔镜胆囊切除术的78例患者,随机将患者分为研究组和对照组,各39例。对照组进行无阿片类药物全麻,研究组在硬膜外麻醉的基础上进行无阿片类药物全麻,记录两组患者麻醉时间、拔管时间、清醒时间。比较两组患者麻醉前、插管后5 min、气腹后5 min、拔管后5 min心率和平均动脉压;比较手术前、气腹后两组患者血糖和皮质醇水平。采用Ramsay镇静评分量表评价患者术后第4、8、12 h镇静效果,采用视觉模拟评分法(VAS)评价患者术后疼痛程度。结果 两组麻醉时间差异无统计学意义(P>0.05),研究组拔管时间、清醒时间短于对照组(P<0.05);插管后5 min,研究组患者心率、平均动脉压低于对照组(P<0.05);其他时间两组心率、平均动脉压比较,差异无统计学意义(P>0.05);气腹后,与对照组比较,研究组血糖、皮质醇水平均降低(P<0.05);术后4、8、12 h,与对照组比较,研究组Ramsay评分增加,VAS评分降低(P<0.05)。结论 无阿片类药物全麻联合硬膜外麻醉能够抑制手术过程中患者机体应激反应,维持患者血流动力学稳定,提升镇静镇痛效果,可在临床中推广使用。

Objective To explore the anesthetic effect of opioid-free anesthesia combined with epidural anesthesia in laparoscopic cholecystectomy.Methods A total of 78 patients who underwent laparoscopic cholecystectomy in the Second People’s Hospital of Anyang from January 2021 to January 2023 were selected as the study subjects.The patients were randomly divided into study group(39 cases)and control group(39 cases).The control group received opioid-free anesthesia,while the study group received opioid-free anesthesia on the basis of epidural anesthesia.The anesthesia time,extubation time and awake time of the two groups of patients were recorded.The heart rate and mean arterial pressure were compared between two groups at four time points:before anesthesia,5 minutes after intubation,5 minutes after pneumoperitoneum and 5 minutes after extubation.The blood glucose and cortisol levels of the two groups of patients were compared before and after surgery.The Ramsay sedation scale was used to evaluate the sedative effect of patients at the 4th,8th,and 12th hours after surgery,and the visual analogue score(VSA)was used to evaluate the degree of postoperative pain.Results There was no statistically significant difference in anesthesia time between the two groups(P>0.05),and the extubation time and awake time in the study group were shorter than those in the control group(P<0.05).Five minutes after intubation,the heart rate and mean arterial pressure of patients in the study group were lower than those in the control group(P<0.05).At other time points,there was no statistically significant difference between the two groups in heart rate and mean arterial pressure(P>0.05).After pneumoperitoneum,compared with the control group,the blood glucose and cortisol levels in the study group were decreased(P<0.05).At 4,8 and 12 hours after surgery,compared with the control group,the Ramsay score in the study group was increased,while the VAS score was decreased(P<0.05).Conclusion Opioid-free anesthesia combined with epidural anesthesia can inhibit the stress response of patients during surgery,maintain the hemodynamic stability of patients,improve the sedative and analgesic effects,it can be widely used in clinical practice.