诺扬经硬膜外间隙超前镇痛对术中知晓的影响

发布时间：2019-05-18 15:02

【摘要】：目的观察术前硬膜外间隙注入小剂量诺扬超前镇痛对术中知晓的影响。方法选择ASA I~II级在全身麻醉复合连续硬膜外麻醉下行妇科开腹手术的患者240例,均未予神经电生理监测,随机均分为A、B、C三组。A组诺扬超前镇痛组,在硬膜外间隙注入足量局麻药后再注入诺扬2 mg;B组吗啡超前镇痛组,在硬膜外间隙注入足量局麻药后再注入吗啡2 mg;C组仅注入局麻药。三组患者监测脑电双频指数(BIS)并保持相同。分别记录三组麻醉时间、停药后意识恢复时间及丙泊酚的用药量,并于意识恢复即刻(T1)、术后6 h(T2)及术后24 h(T3)询问有无术中梦境及术中知晓。结果三组麻醉时间及停药后意识恢复时间差异无统计学意义(P0.05);A组丙泊酚的用药量明显B组,B组丙泊酚的用药量明显C组(P0.05);在各时点(T1、T2、T3),A组患者术中梦境及术中知晓的发生率均为0.00%;B组术中梦境发生率为5.00%、3.75%、2.50%,但无术中知晓发生;C组术中梦境发生率为12.50%、6.25%、5.00%,术中知晓发生率分别为6.25%、3.75%、2.50%。结论硬膜外隙预注小剂量诺扬超前镇痛较吗啡更能降低术中知晓的发生率,值得在临床推广。
[Abstract]:Objective to observe the effect of low dose noyang preemptive analgesia injected into epidural space before operation on intraoperative awareness. Methods 240 patients with ASA I~II grade undergoing gynecological laparotomy under general anesthesia combined with continuous epidural anesthesia were randomly divided into three groups: group A, group B, group C, group A, group B, group C. group A, group C. Injection of sufficient local anesthetics into epidural space and injection of Noyan 2 mg; In group B, morphine preemptive analgesia group was injected with enough local anesthetics in epidural space, and then morphine 2 mg;C group was injected with local anesthetics only. The EEG bispectral index (BIS) was monitored and kept the same in the three groups. The time of anesthesia, the time of consciousness recovery and the dosage of propofol were recorded in the three groups, and the intraoperative dreams and intraoperative knowledge were asked immediately after consciousness recovery (T1), 6 hours after operation (T2) and 24 hours after operation (T3). Results there was no significant difference in anesthesia time and consciousness recovery time after withdrawal among the three groups (P 0.05). The dosage of propofol in group B was significantly higher than that in group B (P 0.05). At all time points (T1, T2, T3), A group, the incidence of intraoperative dreams and intraoperative awareness was 0.00%) in group B (5.00%, 3.75%, 2.50%), but no intraoperative dream occurred. In group C, the incidence of intraoperative dreams was 12.50%, 6.25%, 5.00%, and the incidence of intraoperative awareness was 6.25%, 3.75% and 2.50%, respectively. Conclusion low dose noyang preemptive analgesia with epidural space injection is more effective than morphine in reducing the incidence of preemptive analgesia during operation, which is worth popularizing in clinic.
【作者单位】：大连医科大学附属第一医院麻醉科;
【分类号】：R614

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