目的 观察帕瑞昔布钠预防上腹部手术苏醒期躁动的效果及安全性. 方法 美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级择期行上腹部手术患者120例按随机数字表法分为4组,每组30例.所有患者采用七氟醚、瑞芬太尼复合全麻,术中监测并维持脑电双频指数(bispectral index,BIS)值在40～50,A组于麻醉诱导前静脉注射帕瑞昔布钠0.8 mg/kg,B组于关腹前静脉注射帕瑞昔布钠0.8 mg/kg,C组于关腹前静脉注射静脉给予舒芬太尼0.08 μg/kg,D组于麻醉诱导前静脉注射生理盐水2ml.分别于麻醉诱导前(T1)、拔除气管导管前(停药10 min,T2)、拔管时(T3)、拔管后10 min (T4),观察两组平均动脉压(meanarterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(oxygen saturation,SpO2)及T4时躁动评分(restlessness score,RS)、视觉模拟评分法(visual analogue scales,VAS)、Ramsay镇静评分(ramsay sedation score,RSS)、瑞芬太尼用量、术后30 min恶心呕吐发生率. 结果 苏醒时间,A组、B组、D组分别为(7±3)、(8±4)、(7±3) min显著短于C组(10±4)min(P＜0.05);瑞芬太尼用量,A组为(0.8±0.3) mg,较D组(1.3±0.5)mg明显减少(P＜0.05),差异有统计学意义.D组在T3时间点MAP、HR分别为(126±25) mmHg(1 mmHg=0.133 kPa),(106±28)次/min,较A组[(106±25) mmHg,(96±25)次/min]、B组[(113±27) mmHg,(99±27)次/min]和C组[(111±27) mmHg,(86±19)次/min]升高,差异有统计学意义(P＜0.05),T4时间点也有相似变化.与对照组D组比较,A、B、C组患者术后躁动总发生率分别为6.7％,13.2％,10.0％,均低于对照组术后躁动总发生率33.3％,其中A组躁动总发生率低于B组(P＜0.05).A、B、C组患者VAS评分中位数分别为2、3、2均低于对照组评分5(P＜0.05);A、B、C组患者RSS评分中位数分别为3、3、3均显著低于C组4分(P＜0.05).与C组比较,A、B、D组副作用包括恶心,呕吐,嗜睡,呼吸抑制等发生率均显著低于C组(P＜0.05). 结论 帕瑞昔布钠用于上腹部手术中,可减少瑞芬太尼的用量,并可预防苏醒期躁动与术后恶心呕吐的发生.
目的 觀察帕瑞昔佈鈉預防上腹部手術囌醒期躁動的效果及安全性. 方法 美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級擇期行上腹部手術患者120例按隨機數字錶法分為4組,每組30例.所有患者採用七氟醚、瑞芬太尼複閤全痳,術中鑑測併維持腦電雙頻指數(bispectral index,BIS)值在40～50,A組于痳醉誘導前靜脈註射帕瑞昔佈鈉0.8 mg/kg,B組于關腹前靜脈註射帕瑞昔佈鈉0.8 mg/kg,C組于關腹前靜脈註射靜脈給予舒芬太尼0.08 μg/kg,D組于痳醉誘導前靜脈註射生理鹽水2ml.分彆于痳醉誘導前(T1)、拔除氣管導管前(停藥10 min,T2)、拔管時(T3)、拔管後10 min (T4),觀察兩組平均動脈壓(meanarterial pressure,MAP)、心率(heart rate,HR)、脈搏血氧飽和度(oxygen saturation,SpO2)及T4時躁動評分(restlessness score,RS)、視覺模擬評分法(visual analogue scales,VAS)、Ramsay鎮靜評分(ramsay sedation score,RSS)、瑞芬太尼用量、術後30 min噁心嘔吐髮生率. 結果 囌醒時間,A組、B組、D組分彆為(7±3)、(8±4)、(7±3) min顯著短于C組(10±4)min(P＜0.05);瑞芬太尼用量,A組為(0.8±0.3) mg,較D組(1.3±0.5)mg明顯減少(P＜0.05),差異有統計學意義.D組在T3時間點MAP、HR分彆為(126±25) mmHg(1 mmHg=0.133 kPa),(106±28)次/min,較A組[(106±25) mmHg,(96±25)次/min]、B組[(113±27) mmHg,(99±27)次/min]和C組[(111±27) mmHg,(86±19)次/min]升高,差異有統計學意義(P＜0.05),T4時間點也有相似變化.與對照組D組比較,A、B、C組患者術後躁動總髮生率分彆為6.7％,13.2％,10.0％,均低于對照組術後躁動總髮生率33.3％,其中A組躁動總髮生率低于B組(P＜0.05).A、B、C組患者VAS評分中位數分彆為2、3、2均低于對照組評分5(P＜0.05);A、B、C組患者RSS評分中位數分彆為3、3、3均顯著低于C組4分(P＜0.05).與C組比較,A、B、D組副作用包括噁心,嘔吐,嗜睡,呼吸抑製等髮生率均顯著低于C組(P＜0.05). 結論 帕瑞昔佈鈉用于上腹部手術中,可減少瑞芬太尼的用量,併可預防囌醒期躁動與術後噁心嘔吐的髮生.
목적 관찰파서석포납예방상복부수술소성기조동적효과급안전성. 방법 미국마취의사협회(ASA)분급Ⅰ～Ⅱ급택기행상복부수술환자120례안수궤수자표법분위4조,매조30례.소유환자채용칠불미、서분태니복합전마,술중감측병유지뇌전쌍빈지수(bispectral index,BIS)치재40～50,A조우마취유도전정맥주사파서석포납0.8 mg/kg,B조우관복전정맥주사파서석포납0.8 mg/kg,C조우관복전정맥주사정맥급여서분태니0.08 μg/kg,D조우마취유도전정맥주사생리염수2ml.분별우마취유도전(T1)、발제기관도관전(정약10 min,T2)、발관시(T3)、발관후10 min (T4),관찰량조평균동맥압(meanarterial pressure,MAP)、심솔(heart rate,HR)、맥박혈양포화도(oxygen saturation,SpO2)급T4시조동평분(restlessness score,RS)、시각모의평분법(visual analogue scales,VAS)、Ramsay진정평분(ramsay sedation score,RSS)、서분태니용량、술후30 min악심구토발생솔. 결과 소성시간,A조、B조、D조분별위(7±3)、(8±4)、(7±3) min현저단우C조(10±4)min(P＜0.05);서분태니용량,A조위(0.8±0.3) mg,교D조(1.3±0.5)mg명현감소(P＜0.05),차이유통계학의의.D조재T3시간점MAP、HR분별위(126±25) mmHg(1 mmHg=0.133 kPa),(106±28)차/min,교A조[(106±25) mmHg,(96±25)차/min]、B조[(113±27) mmHg,(99±27)차/min]화C조[(111±27) mmHg,(86±19)차/min]승고,차이유통계학의의(P＜0.05),T4시간점야유상사변화.여대조조D조비교,A、B、C조환자술후조동총발생솔분별위6.7％,13.2％,10.0％,균저우대조조술후조동총발생솔33.3％,기중A조조동총발생솔저우B조(P＜0.05).A、B、C조환자VAS평분중위수분별위2、3、2균저우대조조평분5(P＜0.05);A、B、C조환자RSS평분중위수분별위3、3、3균현저저우C조4분(P＜0.05).여C조비교,A、B、D조부작용포괄악심,구토,기수,호흡억제등발생솔균현저저우C조(P＜0.05). 결론 파서석포납용우상복부수술중,가감소서분태니적용량,병가예방소성기조동여술후악심구토적발생.
Objective To observe the preventive effects of parecoxib sodium on occurring of emergence agitation during the recovery period of general anesthesia for the patients who underwent epigastric surgeries.Methods one hundred and twenty patients,ASA Ⅰ ～ Ⅱ,underwent elective epigastic surgeries were divided randomly into four groups,30 cases in each group.Anesthesia of all patients was maintained with sevoflurane and remifentanil,keeping the bispectral index (BIS) around 40-50.Parecocib 0.8 mg/kg was intravenously infused into the patients just before anesthesia induction in group A and just before the closure of peritoneum in group B,Sufentanil 0.08 μg/kg was injected just before the closure of peritoneum in group C,2 ml saline as placebo was administrated in group D.The level of agitation(RS),visual analogue scales(VAS) and ramsay sedation score(RSS) were evaluated during the recovery period of general anesthesia.Mean arterial pressure(MAP) and heart rate(HR)were monitored at preinduction (T1),10 min before tracheal extubation (T2),immediately after tracheal extubation (T3) and 10 min after tracheal extubation (T4).Results The recovery time of group A,B,D(7±3),(8±4),(7±3) min is significantly shorter than that of group C.Requirement of remifentanil in group A (0.8±0.3) mg is significantly lower than that of group D (1.3±0.5) mg (P＜0.05).At T3,the MAP and HR in group D(126±25) mmHg(1 mmHg=0.133 kPa)(106±28) beats/min were significantly higher than those in group A [(106±25) mmHg,(96±25) beats/min],group B [(113±27) mmHg,(99±27) beats/min],group C [(111±27) mmHg,(86± 19) beats/min](P＜0.05),which happened similarly at T4.Compared with group D,the incidence of agitation (33.3％) is significantly higher than that of group A (6.7％),group B (13.2％) and group C (10.0％) (P＜0.05),and the incidence of agitation group A is significantly lower than group B (P＜0.05).Compared with group D,the median of score of VAS is 5,which is significantly higher than that of group A (2),group B (3),and group C (2) (P＜0.05),Compared with group D,the median of score of RSS is 4,which is significantly higher than that of group A (3),group B (3) and group C (3) respectively (P＜0.05).The incidence of nausea and vomiting of group C is much higher than other groups significantly (P＜0.05).Conclusions Parecoxib sodium has an analgesic effect for the patients of epigastric surgeries,preventing the incidence of postoperative agitation and adverse reactions during the recovery period of general anesthesia.
