鎮痛銜接預防全麻蘇醒期躁動的臨床研究

王玲+彭洪+匡顯發+周兵+袁婉秋+楊文

【摘要】 目的：觀察鎮痛銜接對全麻蘇醒期躁動的預防作用。方法：選取60例擇期行全麻后腹部手術的患者，隨機分為A、B、C三組；三組均行相同的麻醉處理，手術結束前10 min，A組靜注芬太尼1 μg/kg，B組靜注氟比洛芬酯1 mg/kg，C組患者不注入任何止痛藥物；分別記錄三組患者基礎值、拔管前及拔管后5、10、30 min的MAP、HR值及血氧飽和度，記錄拔管過程中咳嗽情況，拔管即刻、拔管后5、10、30 min的VAS評分及蘇醒期SAS評分等數據進行對比研究。結果：三組間不同時刻的MAP、HR和SpO2值以及不同時刻的VAS評分和患者蘇醒期SAS評分比較，差異均有統計學意義（P<0.05）；三組MAP、HR和SpO2值均隨時間的延長而顯著變化，VAS評分均隨時間的延長而顯著上升，差異均有統計學意義（P<0.01）；三組MAP、HR和SpO2值隨時間的變化幅度比較，差異均有統計學意義（P<0.05），C組變化幅度明顯大于A、B兩組，且C組VAS評分、SAS評分以及蘇醒期躁動發生率均顯著高于A、B兩組（P<0.05），C組患者拔管過程中容易出現持續咳嗽，患者鎮痛效果較差，容易出現躁動。A、B兩組間不同時刻的MAP、HR值、不同時刻的VAS評分、蘇醒期SAS評分以及躁動發生率比較，差異均無統計學意義（P>0.05），拔管后5 min A組患者SpO2值顯著低于B組（P<0.05），且A組患者咳嗽發生情況顯著高于B組（P<0.05）。結論：將鎮痛銜接理念應用于全麻蘇醒期患者的預防，可以很好地減少躁動發生，有助于維持患者拔管過程中心率及血壓穩定，氟比洛芬酯及芬太尼均可以實現良好的鎮痛銜接效果，有效減少躁動發生，但氟比洛芬酯與芬太尼相比，對呼吸的抑制作用較小。

【關鍵詞】 鎮痛銜接； 蘇醒期躁動； 氟比洛芬酯

Clinical Study of Analgesia in Preventing Emergence Agitation During General Anesthesia/WANG Ling，PENG Hong，KUANG Xian-fa，et al.//Medical Innovation of China，2017，14（11）：009-012

【Abstract】 Objective：To observe the effect of analgesia in preventing emergence agitation during the recovery period of general anesthesia.Method：60 patients undergoing abdominal surgery after general anesthesia were randomly divided into A，B，C three groups.The three groups underwent the same anesthesia，10 min before the end of surgery，group A intravenous Fentanyl 1 μg/kg，group B intravenous injection of Flurbiprofen Axetil 1 mg/kg，group C was not injected any analgesic drug.Three groups were recorded baseline values before extubation and 5，10，30 min，MAP，HR value and oxygen saturation，cough during extubation，extubation time，comparative study of 5，10，30 min，VAS score and SAS score data recovery period after extubation.Result：Among three groups at different time of MAP，HR and SpO2 value and VAS score，and SAS score of patients in recovery period were statistically different（P<0.05），three groups of MAP，HR and SpO2 were significantly changed with the extension of time，VAS scores were significantly increased（P<0.01），three groups of MAP，HR and SpO2 value variation with time were statistically differences，the changes of group C were significantly greater than those of group A，B，and VAS score，SAS score and restlessness incidence were significantly higher than those of group A，B（P<0.05），group C appeared easily during extubation in patients with persistent cough，poor analgesic effect of patients prone to restlessness.Group A and B at different times MAP，HR value and VAS score，SAS score and the recovery period of restlessness incidence were not statistically significant（P>0.05），5 min after extubation in group A patients with SpO2 was significantly lower than that of group B（P<0.05），and group A in patients with cough occurrence was significantly higher than that of group B.Conclusion：The analgesic prevention concept applied to the convergence of general anesthesia patients，can reduce the incidence of agitation，help keeping extubation in patients with heart rate and blood pressure，Flurbiprofen and Fentanyl can achieve good analgesic effect of cohesion，effectively reduce the occurrence of agitation，but Flurbiprofen compared with Fentanyl，small inhibition of respiration.