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| 镇痛指数指导瑞芬太尼靶控输注在腹腔镜下胃大部切除术中的应用 |
| Application of target-controlled infusion of remifentanil guided by pain threshold index in laparoscopic subtotal gastrectomy |
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| DOI：10.12089/jca.2020.07.002 |
| 中文关键词: 镇痛指数 瑞芬太尼 靶控输注 腹腔镜下胃大部切除术 |
| 英文关键词: Pain threshold index Remifentanil Target controlled infusion laparoscopic subtotal gastrectomy |
| 基金项目:国家自然科学基金（34100940） |
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| 中文摘要: |
目的 评估镇痛指数（PTi）监测下瑞芬太尼靶控输注在腹腔镜下胃大部切除术中的临床效果。
方法 选择行择期腹腔镜下胃大部切除术的胃癌患者50例，男28例，女22例，年龄30~70岁，BMI 18~25 kg/m2，ASA Ⅰ或Ⅱ 级。采用随机抽取原则将患者分为两组：PTi组（P组）和对照组（C组），每组25例。P组使用 HXD-I多功能组合式监护仪进行脑电监测，根据PTi调节瑞芬太尼血浆浓度，维持PTi在40~60。C组持续静脉泵入瑞芬太尼0.1~0.3 μg·kg-1·min-1进行麻醉维持，根据手术刺激适当调节剂量。记录麻醉时间、苏醒时间、拔管时间和瑞芬太尼使用量。记录苏醒后即刻、苏醒后15、30 min时的VAS评分。记录麻醉诱导前、切皮后1、2 h、苏醒后即刻时血清中应激激素促肾上腺皮质激素（ACTH）、血管紧张素Ⅱ（Ang Ⅱ）、β-内啡肽（β-EP）和血糖（Glu）浓度。
结果 与C组比较，P组苏醒时间和拔管时间均明显缩短 (P<0.05)，瑞芬太尼使用量明显降低(P<0.05)，麻黄碱和阿托品使用率明显降低(P<0.05)，切皮后1、2 h、苏醒后即刻时P组ACTH、Ang Ⅱ、β-EP和Glu明显降低 (P<0.05)，苏醒后即刻、苏醒后15、30 min时P组VAS评分均明显降低(P<0.05)。两组麻醉时间差异无统计学意义。与麻醉诱导前比较，切皮后1、2 h、苏醒后即刻时两组ACTH、Ang Ⅱ、β-EP和Glu明显升高(P<0.05)。
结论 腹腔镜下胃大部切除术患者在PTi监测下靶控输注瑞芬太尼,这更接近或符合指导精准麻醉，实现全麻术中镇痛药物安全合理的应用。 |
| 英文摘要: |
Objective To evaluate the clinical effect of target controlled infusion of remifentanil under pain threshold index (PTi) monitoring in laparoscopic subtotal gastrectomy.
Methods Fifty patients, 28 males and 22 females, aged 30-70 years, BMI 18-25 kg/m2, falling into ASA physical statusⅠ or Ⅱ, undergoing elective laparoscopic subtotal gastrectomy, were divided into 2 groups: pain threshold index group (group P, n = 25) and control group (group C, n = 25). In group P, the HXD-I multi-function combination monitor was used for electroencephalogram monitoring.The plasma concentration of remifentanil was adjusted according to the PTi, and the PTi was maintained at 40-60. In group C, the patient was continuously intravenously administrated with 0.1-0.3 μg·kg-1·min-1 of remifentanil for anesthesia maintenance, and the dose was appropriately adjusted according to the surgical stimulation.The anesthesia time, recovery time, extubation time, and the doses of remifentanil were recorded. The VAS scores of the two groups were recorded immediately after awakening and at 15 and 30 min after awakening. The differences in serum stress hormones adrenocorticotropic hormone (ACTH), angiotensin Ⅱ(Ang Ⅱ), β-endorphin (β-EP), and blood glucose (Glu) levels between the two groups before anesthesia induction, 1 and 2 h after skin incision, immediately after waking were compared.
Results Compared with group C, the recovery time and extubation time in group P were significantly shortened (P < 0.05), the amount of remifentanil was significantly reduced (P < 0.05), and the use rate of ephedrine and atropine was significantly decreased (P < 0.05). There was no significant difference in anesthesia time between the two groups.VAS scores in group P were significantly lower than those in group C immediately after awakening and at 15 and 30 min after awakening (P < 0.05). Compared with that before anesthesia induction, ACTH, Ang Ⅱ, β-EP and Glu were significantly increased in the two groups at 1 and 2 h after skin incision, immediately after waking (P < 0.05). ACTH, Ang Ⅱ, β-EP, and Glu in group P were significantly lower than those in group C at 1 and 2 h after skin incision, immediately after waking (P < 0.05).
Conclusion Targeted infusion of remifentanil under the monitoring of PTi in patients undergoing laparoscopic subtotal gastrectomy is more in line with the guidance of precision anesthesia and the safe and reasonable application of analgesic drugs during general anesthesia. |
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