持续输注艾司洛尔对腹腔镜胆囊切除术雷米芬太尼麻醉诱导后患者痛觉过敏的影响

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摘要目的观察分析持续输注艾司洛尔对腹腔镜胆囊切除术雷米芬太尼麻醉诱导后患者痛觉过敏的影响。方法选取2015年2月～2016年4月于本院择期行腹腔镜胆囊切除术的88例患者，根据入院时间顺序分为研究组与对照组，每组44例。对照组患者于麻醉诱导前静脉注射生理盐水，持续输注至拔除气管导管即刻，研究组患者给予等量艾司洛尔持续输注。记录比较两组患者的体征变化、雷米芬太尼的用量和气管拔管时间及术后不良反应情况。结果对照组气管插管时（T1）、拔除气管导管时（T3）的平均动脉压与心率均明显高于麻醉诱导前（T0），差异有统计学意义（P＜0.05）。研究组在T1、T3时的平均动脉压与心率均明显低于对照组，差异有统计学意义（P＜0.05）。研究组在术后2、6、12、24 h各个时间点的VSA评分均明显低于对照组，差异有统计学意义（P＜0.05）。研究组的术中气管拔管时间和雷米芬太尼的用量明显少于对照组，差异有统计学意义（P＜0.05）。研究组的术后恶心呕吐发生率（4.55%）明显低于对照组（25.00%），差异有统计学意义（P＜0.05）。结论腹腔镜胆囊切除术患者围术期给予艾司洛尔可安全有效地减轻雷米芬太尼麻醉后诱发的痛觉过敏，减少术中雷米芬太尼的用量，维持患者血流动力学稳定，降低恶心呕吐发生率。

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	彭娟
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关键词 ：艾司洛尔, 腹腔镜胆囊切除术, 雷米芬太尼, 痛觉过敏

Abstract：ObjectiveToobserveandanalyzetheeffectofcontinuousinfusionofEsmololonhyperalgesiainpatientsundergoing laparoscopic cholecystectomy after induction of anesthesia with Remifentanil.Methods88 patients undergoing elective laparoscopic cholecystectomy in our hospital from February 2015 to April 2016 were selected.According to the admission order,the patients were divided into the study group and the control group,with 44 patients in each group.The patients in the control group were given intravenous injection of normal saline before induction of anesthesia and the infusion was continued until the immediate time point of removing the tracheal tube.Patients in the study group were given equal amounts of Esmolol for continuous infusion.The changes of signs,the dosage of Remifentanil,tracheal extubation time and postoperative adverse reactions were recorded and compared between the two groups.ResultsMAP and HR at the time of tracheal intubation (T1)and at the time of extubation (T3)were significantly higher than those before anesthesia induction(T0)in the control group,with significant difference(P＜0.05).The MAP and HR in the study group at T1and T3were significantly lower than those in the control group,with significant difference(P＜0.05).The VSA scores in the study group at 2,6,12,24 h after surgery were significantly lower than those in the control group,with significant difference (P＜0.05).The time of tracheal extubation and the dosage of Remifentanil in the study group were significantly lower than that in the control group,with significant difference(P＜0.05).The incidence rate of postoperative nausea and vomiting in the study group was (4.55%),which was significantly lower than that in the control group(25.00%),and the differences were significant (P＜0.05).ConclusionPerioperative administration of Esmolol in the patients undergoing laparoscopic cholecystectomy can safely and effectively reduce the hyperalgesia induced by Remifentanil anesthesia induction.The dosage of Remifentanil is reduced intraoperatively,hemodynamic stability in patients is maintained,and the incidence rate of nausea and vomiting is lowered.

Key words： Esmolol Laparoscopiccholecystectomy Remifentanil Hyperalgesia

基金资助:江西省南昌市指导性科技计划项目（洪科发计字[2013]210号，项目编号：25）

作者简介: 彭娟（1983-），女，本科，主治医师，主要研究方向：麻醉方法以及麻醉药品的临床应用

引用本文:

彭娟;周艳;王宁平. 持续输注艾司洛尔对腹腔镜胆囊切除术雷米芬太尼麻醉诱导后患者痛觉过敏的影响[J]. 中国当代医药, 2017, 24(32): 108-111.
PENG Juan;ZHOU Yan;WANG Ning-ping. Influence of continuous infusion of Esmolol on hyperalgesia in patients undergoing laparoscopic cholecystectomy after induction of anesthesia with Remifentanil. 中国当代医药, 2017, 24(32): 108-111.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2017/V24/I32/108

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