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| 术中持续静脉输注硫酸镁对日间腹腔镜胆囊切除术后早期恢复质量的影响 |
| Effect of intravenous infusion of magnesium sulfate on early postoperative recovery quality in patients undergoing day-case laparoscopic cholecystectomy |
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| DOI：10.12089/jca.2025.02.006 |
| 中文关键词: 硫酸镁 日间手术 腹腔镜胆囊切除术 术后恢复质量 |
| 英文关键词: Magnesium sulfate Day-case surgery Laparoscopic cholecystectomy Quality of postoperative recovery |
| 基金项目:首都卫生发展科研专项（首发2022-2Z-2039） |
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| 中文摘要: |
目的：观察术中持续静脉输注硫酸镁对日间腹腔镜胆囊切除术（LC）患者术后恢复质量的影响。
方法：选择择期在全麻下行日间LC患者88例，男40例，女48例，年龄18～64岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ或Ⅱ级。采用SPSS软件将患者随机分为两组：硫酸镁组（M组）和生理盐水组（C组），每组44例。M组插管前静脉输注硫酸镁20 mg/kg，术中持续泵注硫酸镁20 mg·kg-1·h-1；C组静脉输注等容量生理盐水。记录术中瑞芬太尼和丙泊酚用量、术中血管活性药物使用情况、拔管时间、拔管时和出PACU时Ramsay镇静评分、PACU内补救镇痛例数。记录插管前、插管后、气腹开始10 min、胆囊切除后、拔管时的HR和MAP。记录术前1 h和术后24 h的15项恢复质量（QoR-15）量表评分、差值（术前1 h-术后24 h）达到QoR-15量表最小临床重要差异值（MCID）的例数。记录拔管时、出PACU时和术后24 h VAS疼痛评分。记录术中低血压、心动过缓、药物过敏和术后恶心呕吐、肩背痛/胃痛等不良反应的发生情况。
结果：与C组比较，M组术中瑞芬太尼用量明显减少（P<0.05）；术后24 h QoR-15评分明显升高，在疼痛、身体舒适度、自理能力和情绪状态4个维度评分明显升高（P<0.05），QoR-15量表差值达到MCID的比例明显降低（P<0.05）；出PACU时和术后24 h VAS疼痛评分明显降低（P<0.05）；术后恶心、肩背痛/胃痛发生率明显降低（P<0.05）。
结论：日间LC患者术中持续静脉输注硫酸镁对患者早期恢复质量影响不明显，可减少术中阿片类药物用量，减轻术后早期疼痛，降低不良反应发生率。 |
| 英文摘要: |
Objective: To observe the effect of intravenous infusion of magnesium sulfate on early postoperative recovery quality in patients undergoing day-case laparoscopic cholecystectomy.
Methods: Eighty-eight patients, 40 males and 48 females, aged 18-64 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, undergoing day-case laparoscopic cholecystectomy were selected. The patients were randomly divided into two groups by SPSS: magnesium sulfate group (group M) and normal saline group (group C), 44 patients in each group. The patients in group M received 20 mg/kg magnesium sulfate intravenously before intubation, followed by continuous infusion 20 mg·kg-1·h-1. The patients in group C received the same dose of normal saline intravenously. Intraoperative dosage of remifentanil and propofol, intraoperative use of vasoactive drugs, extubation time, Ramsay sedation score at extubation and out of PACU, and number of remedial analgesia cases in PACU were recorded. HR and MAP were recorded before and after intubation, 10 minutes after pneumoperitoneum, after gallbladder resection, and during extubation. The 15-item quality of recovery (QoR-15) scale scores were recorded 1 hour before surgery and 24 hours after surgery, and the difference value of the QoR-15 scale reaching minimal clinically important difference (MCID) were recorded. The VAS pain scores at extubation, discharge from PACU, and 24 hours after surgery were recorded. The occurrence of intraoperative hypotension, bradycardia, drug allergy, postoperative nausea and vomiting, shoulder and back pain/stomach pain, and other adverse reactions were recorded.
Results: Compared with group C, group M showed a significant reduction in intraoperative remifentanil consumption and had a higher QoR-15 score 24 hours after surgery (P < 0.05). The scores of pain, physical comfort, self-care ability, and emotional state were significantly higher in group M than in group C (P < 0.05). The number of patients who reached the MCID value of QoR-15 scale in group M was significantly lower compared with group C (P < 0.05). Group M exhibited a substantial decrease in VAS scores at the PACU and 24 hours after surgery (P < 0.05), and a significant decrease in the incidence of postoperative nausea and shoulder pain/stomach pain in comparison to group C (P < 0.05).
Conclusion: Magnesium sulfate has insignificant effect on the quality of early postoperative recovery for patients undergoing day-case laparoscopic cholecystectomy, but reduce postoperative pain, lessen intraoperative opiates intake and the risk of adverse reactions. |
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