全凭静脉麻醉下不同麻醉深度对下腹部剖腹手术患者术后痛觉过敏的影响

发布时间：2018-05-20 01:24

本文选题：全凭静脉麻醉 + 脑电双频指数　；参考：《临床麻醉学杂志》2017年04期

【摘要】：目的通过观察全凭静脉麻醉下行下腹部剖腹手术患者术后痛觉过敏发生情况,研究不同麻醉深度对下腹部剖腹手术后痛觉过敏的影响。方法选择40例妇科择期行下腹部剖腹手术患者按照麻醉深度不同分为B1组(维持BIS 40~49)和B2组(BIS 50~59),每组20例。两组均采用全凭静脉气管插管全麻。测量患者触痛阈及机械痛觉过敏范围的基础值;记录两组患者术中静脉麻醉药用量、清醒时间及拔管时间;记录患者入室后(T_0)、探查腹腔时(T_1)、手术结束时(T_2)、拔管后1h(T_3)、4h(T_4)、12h(T_5)、24h(T_6)、48h(T_7)的MAP、HR;记录T_3~T_7的VAS评分;记录术后第1天及第2天镇痛泵具体用药量、追加PCA次数等情况;采用纤毛机械刺激针(Von Frey Hairs)测定术后T_6和T_7的触痛阈及机械痛觉过敏范围。结果 B1组T6、T7时MAP明显低于,T_2、T_4时HR明显慢于B2组(P0.05)。T_6和T_7时B1组切口下部触痛阈明显低于,切口上、下部机械痛觉过敏范围明显长于T_0时(P0.05);T_6和T7时B2组切口上、中、下部触痛阈明显低于,机械痛觉过敏范围明显长于T_0时,但T_7时切口上、中、下部触痛阈明显高于T_6时(P0.05)。T_7时B1组切口上、中、下点机械痛觉过敏范围明显短于B2组(P0.05)。结论全凭静脉麻醉中维持患者的BIS值在40~49的状态可以减轻术后机体的应激反应,减轻术后痛觉过敏的发生,且术后48h机械痛觉过敏范围的恢复较快。
[Abstract]:Objective to study the effect of different anesthetic depth on postoperative hyperalgesia in patients undergoing lower abdominal laparotomy under total intravenous anesthesia. Methods Forty gynecological patients undergoing elective lower abdominal laparotomy were divided into B1 group (maintaining BIS 4049) and B2 group (20 cases in each group) according to the depth of anesthesia. Both groups were treated with total intravenous tracheal intubation anesthesia. The threshold of tenderness and the range of mechanical hyperalgesia were measured, and the dosage of intraoperative intravenous anesthetics, waking time and extubation time were recorded. The VAS scores of T_3~T_7 were recorded at the end of the operation, 1 hour after the extubation, 1 h after the extubation, 12 h, T5, 24 h, and 48 h, respectively. The VAS score of the T_3~T_7 was recorded, and the specific dosage of the analgesic pump on the first day and the second day after the operation was recorded, and the number of additional PCA was recorded. The tenderness threshold and the range of mechanical hyperalgesia were measured by means of ciliated mechanical stimulation (Von Frey Hairs) after the operation of T _ (6) and T _ (7). Results MAP in group B1 was significantly lower than that in group B _ (2) at T6 / T _ 7, HR was significantly slower than that in group B _ (2) when compared with that in group B _ (2) (P _ (0.05) 路T _ (6) and T _ (7). The range of mechanical hyperalgesia in group B1 was significantly longer than that in group B _ (2) at T _ (0) and T _ 7 (P _ (0.05) T _ (6) and T _ (7). The lower tenderness threshold was significantly lower and the range of mechanical hyperalgesia was significantly longer than that of TSP 0, but at T7, the middle and lower tenderness threshold was significantly higher than that in group B1 at T6, and the range of mechanical hyperalgesia at the lower point was significantly shorter than that in group B2. Conclusion maintenance of BIS value at 40 ~ 49 during total intravenous anesthesia can reduce the stress response and the occurrence of postoperative hyperalgesia, and the range of mechanical hyperalgesia can recover more quickly at 48 hours after operation. [WT5HZ] [WT5 "HZ] [WT5" BZ] [WT5 "BZ] [WT5BZ]
【作者单位】：广西医科大学第一附属医院麻醉科;
【基金】：基金项目:广西医疗卫生适宜技术研究与开发(S201414-06)
【分类号】：R614

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