无阿片药麻醉对腹腔镜胆囊切除术后恶心呕吐的影响

Effect of balanced opioid-free anesthesia on postoperative nausea and vomiting after laparoscopic cholecystectomy

目的探讨无阿片药麻醉(OFA)对腹腔镜胆囊切除术(LC)后患者恶心呕吐及恢复质量的影响。方法采用随机数字表法将99例拟择期行LC的患者分为两组:对照组(OA组,50例)和OFA组(49例)。OA组以舒芬太尼等药物诱导麻醉,瑞芬太尼复合七氟醚维持麻醉;OFA组使用艾司氯胺酮等诱导并以艾司氯胺酮复合七氟醚维持麻醉。观察两组患者术后24 h内恶心、呕吐[术后恶心呕吐(post operative nausea and vomiting,PONV)]及其他不良反应发生率,术前及术后24 h、48 h、7 d 40项恢复质量量表(QoR-40)评分,术中各时点[入室时(T1)、插管后1 min(T2)、手术开始时(T3)、牵拉胆囊时(T4)、手术结束时(T5)]血流动力学[平均动脉压(MAP)、心率]情况,麻醉及术中资料情况等。结果与OA组比较:OFA组术后24 h内PONV、呕吐、腹胀发生率,术中去氧肾上腺素使用量,T3~T5时心率,T2~T5时MAP较低(均P<0.05);麻醉后监测治疗室(PACU)停留时间较少(P<0.05);术后24 h身体舒适度、身体自理及疼痛评分,术后48 h QoR-40评分及其情绪状态、身体舒适度评分较高(均P<0.05)。与术前比较:两组患者术后24、48 h QoR-40评分及其身体舒适度、疼痛评分降低(均P<0.05);术后24 h情绪状态、身体自理评分降低(均P<0.05);术后7 d QoR-40评分及其情绪状态、疼痛评分升高(均P<0.05)。其余指标差异无统计学意义(均P>0.05)。结论OFA可以减少LC术后24 h内PONV及呕吐、腹胀发生率,提供更好的血流动力学稳定性;对患者术后恢复质量的提高具有统计学意义,但不具有临床意义。

Objective To explore the effect of opioid-free anesthesia(OFA)on nausea and vomiting and recovery quality of patients after laparoscopic cholecystectomy(LC).Methods According to the random number table method,99 patients who under-went elective laparoscopic cholecystectomy were divided into two groups:an control group(OA group)(n=50)and an OFA group(n=49).In the OA group,anesthesia was inducted with sufentanil and other drugs and maintained with remifentanil combined with sevoflu-rane.In contrast,esketamine was used for anesthesia induction in the OFA group,followed by anesthesia maintenance with esketamine combined with sevoflurane.Then,the incidence of nausea and vomiting[postoperative nausea and vomiting(PONV)]and other adverse reactions within 24 h after operation,the 40-items Quality of Recovery Scale(QoR-40)scores before surgery and at postoperative 24 h,48 h and 7 d were recorded;the hemodynamics[mean arterial pressure(MAP),and heart rate]at each point of the operation[at admis-sion(T1),1 min after intubation(T2),at the beginning of the operation(T3),at the time of pulling the gallbladder(T4),and at the end of the operation(T5)]were recorded,anesthesia and intraoperative data were recorded in the two groups.Results Compared with the OA group,the OFA group showed decreases in the incidences of PONV,vomiting,abdominal distension and intraoperative phenyleph-rine consumption within postoperative 24 h,heart rate at T3‒T5,and MAP at T2‒T5(all P<0.05);reduction in the length of post-anes-thesia care unit(PACU)stay(P<0.05);and increases in physical comfort,physical self-care,and pain scores within postoperative 24 h,and QoR-40 scores,their emotional state and physical comfort scores at postoperative 48 h(all P<0.05).Compared with those before surgery,patients in both groups presented decreases in QoR-40 scores,physical comfort and pain scores at postoperative 24 h and 48 h(all P<0.05);decreases in emotional state and physical self-care scores at postoperative 24 h(all P<0.05);and increases in QoR-40 scores,emotional state and pain scores at postoperative 7 day(all P<0.05).The differences in the remaining indicators were not statisti-cally significant(all P>0.05).Conclusions OFA can reduce the incidence of PONV,vomiting and abdominal distension within 24 h after LC,and provide better hemodynamic stability.It is statistically but not clinically significant in improving the quality of patients'postoperative recovery.