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| 不同麻醉诱导方案用于妇科腹腔镜手术的效果比较 |
| 作者：鲁学文1 刘月江1 翟盼盼1 周敏1 毛雯雯1 鲍倡俊2 |
| 单位：1. 东南大学附属中大医院 麻醉科, 江苏 南京 210009; 2. 江苏省疾病预防与控制中心, 江苏 南京 210009 |
| 关键词：羟考酮 腹横肌平面阻滞 全麻诱导 腹腔镜 |
| 分类号：R614.2 |
| 出版年·卷·期（页码）：2019·38·第六期（1049-1054） |
| 摘要： |
目的：比较3种麻醉诱导方案用于妇科腹腔镜手术的效果。方法：将120例择期行妇科腹腔镜手术患者随机分为舒芬太尼组（S组）、羟考酮组（Q组）和羟考酮联合腹横肌平面阻滞组（Q-TAP组），每组40例。分别以舒芬太尼和羟考酮诱导全麻，Q-TAP组插管后在B超引导下行双侧腹横肌平面（TAP）阻滞（每侧注射0.375%罗哌卡因20 ml）。观察并记录麻醉插管过程中患者心率、收缩压的变化，术中及术后镇痛药物用量，拔管时间，麻醉后恢复室（PACU）停留时间，拔管后30 min和术后2、4、8、24 h患者疼痛视觉模拟（VAS）评分，以及术后24 h内麻醉相关并发症（恶心、呕吐、头晕、嗜睡、呼吸抑制等）的发生情况。结果：Q-TAP组术中瑞芬太尼用量、术后VAS评分明显低于Q组和S组；Q组、Q-TAP组插管后1 min心率波动、PACU内镇痛补救次数明显少于S组（P < 0.05），拔管时间、PACU停留时间、术后麻醉相关并发症3组间差异无统计学意义。结论：与舒芬太尼比较，羟考酮诱导全麻用于妇科腹腔镜手术可以减轻插管时心率波动，不影响麻醉恢复；羟考酮诱导全麻复合TAP阻滞用于妇科腹腔镜手术可明显减少术中及术后早期阿片类药物用量，减轻术后疼痛，且不增加不良反应发生率。 |
Objective: To compare the effects of three kinds of anesthesia induction schemes for gynecological laparoscopic surgery. Methods: One hundred and twenty patients underwent gynecological laparoscopic surgery were randomly divided into sufentanil group (S group), oxycodone group (Q group) and oxycodone combined with transverse abdominal muscle block group (Q-TAP group), each group containing 40 patients. General anesthesia was induced by sufentanil and oxycodone respectively. In the Q-TAP group, bilateral TAP block was conducted under B-ultrasound guidance after intubation(0.375% ropivacaine 20 ml was injected into each side). The changes of heart rate (HR) and systolic blood pressure of the patients during intubation, intraoperative and postoperative opioids consumption, extubation time, postanesthesia care unit (PACU) stay time, visual analogue scale (VAS) pain score of the patients 30 min after extubation, 2, 4, 8 and 24 hours after surgery, and the occurrence of anaesthesia related complications (nausea, vomiting, dizziness, drowsiness, respiratory inhibition) were observed and recorded. Results: The intraoperative remifentanil consumption and postoperative VAS pain score of Q-TAP group were significantly lower than those of Q group and S group (all P < 0.05). The fluctuations of HR during intubation were smaller and the frequency of analgesic relief in PACU was lower in Q group and Q-TAP group than those in S group (P < 0.05). There were no statistical difference in extubation time, PACU stay time, and postoperative complications among the three groups. Conclusion: Compared with sufentanil, general anesthesia induced with oxycodone can reduce the HR fluctuation during intubation. General anesthesia induced with oxycodone combined with TAP block for gynecological laparoscopic surgery can reduce intraoperative and early postoperative opioid consumption, and improve postoperative analgesia, without complication increase. |
| 参考文献： |
[1] 王媛媛,崔晓光.腹腔镜手术镇痛的新进展[J].医学综述,2018,24(3):987-991. |
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