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| 去阿片化麻醉在泌尿外科短小手术中的应用 |
| Application of opioid-free anesthesia in short urological surgery |
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| DOI：10.12089/jca.2022.12.010 |
| 中文关键词: 去阿片化麻醉 艾司氯胺酮 右美托咪定 瑞芬太尼 泌尿外科手术 全身麻醉 |
| 英文关键词: Opioid-free anesthesia Esketamine Dexmedetomidine Remifentanil Urological surgery General anesthesia |
| 基金项目:南京医科大学科技发展基金（NUMB2020053） |
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| 中文摘要: |
目的 探讨去阿片化麻醉在泌尿外科短小手术中的应用效果。
方法 选择2021年8—12月行泌尿外科短小手术患者60例，男40例，女20例，年龄18～64岁，BMI 18～28 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：去阿片化麻醉组（F组）和瑞芬太尼麻醉组（R组），每组30例。F组使用艾司氯胺酮复合右美托咪定进行麻醉维持，R组使用瑞芬太尼复合丙泊酚进行麻醉维持。记录麻醉诱导前（T0）、麻醉诱导后即刻（T1）、喉罩置入后（T2）、麻醉诱导后10 min（T3）、喉罩移除前（T4）、喉罩移除后（T5）的HR、SBP、DBP和BIS。记录麻醉苏醒时间、术后30 min、24 h VAS疼痛评分分级和术后不良反应的发生情况。
结果 与T0时比较，R组T1—T4时HR明显减慢，T1—T5时SBP、DBP明显降低（P<0.05）。与R组比较，F组T1—T3时HR明显增快，T2—T4时SBP、DBP明显升高，T2、T3时BIS明显升高（P<0.05）。两组麻醉苏醒时间、术后30 min、24 h VAS疼痛评分分级、恶心呕吐、睡眠紊乱等不良反应发生率差异均无统计学意义。
结论 去阿片化麻醉可安全用于泌尿外科短小手术，且术中血流动力学更稳定。 |
| 英文摘要: |
Objective To explore the application of opioid-free anesthesia in short urological surgery.
Methods Sixty patients from August 2021 to December 2021 underwent short urological surgery, 40 males and 20 females, aged 18-64 years, BMI 18-28 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly devided into two groups using random number table method: opioid-free anesthesia group (group F) and remifentanil group (group R), 30 patients in each group. Patients in group F received esketamine and dexmedetomidine, while patients in group R received remifentanil and propofol. The HR, SBP, DBP, and BIS in both groups were observed and recorded before anesthesia induction (T0), immediately after anesthesia induction (T1), after laryngeal mask implantation (T2), 10 minutes after anesthesia induction (T3), before (T4) and after (T5) laryngeal mask removal. The anesthesia recovery time, VAS pain score 30 minutes and 24 hours after surgery, and the incidence of postoperative adverse events were also recorded.
Results HR at T1-T4 was significantly lower than that at T0 and the SBP and DBP at T1-T5 were significantly lower than that at T0 in group R (P < 0.05). HR at T1-T3 in group F was significantly higher than that in group R (P < 0.05). SBP, DBP at T2-T4, and BIS at T2, T3 in group F were significantly higher than that in group R (P < 0.05). There were no significant differences in anesthesia recovery time, VAS pain score 30 minutes and 24 hours after surgery, and the incidence of postoperative pain, nausea and vomiting, sleep disturbance and other adverse events between the two groups.
Conclusion Opioid-free anesthesia is safe in short urological surgery with more stable intraoperative hemodynamics. |
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