全凭静脉麻醉对腔镜下甲状腺手术的苏醒躁动及术后镇痛效果的影响

目的:探讨全凭静脉麻醉(TIVA)对腔镜下甲状腺手术的苏醒躁动及术后镇痛效果的影响。方法:将74例接受腔镜下甲状腺手术的患者随机分为TIVA组与静吸复合麻醉(VICA)组,每组各37例。比较两组诱导麻醉前(T0)、切皮后1 min(T1)、手术开始后30 min(T3)、手术结束时(T3)及术后30 min(T4)血糖(GLU)、血清皮质醇(COR)、白介素(IL-6)水平的变化、麻醉药物用量、术后自主呼吸恢复时间、苏醒时间、拔管时间、苏醒期躁动及术后镇痛效果。结果:T1时刻,两组GLU、COR、IL-6水平均呈现出不同程度升高,而TIVA组T1~T4时刻各指标均较VICA组明显降低(P0.05)。与VICA组比较,TIVA组丙泊酚的术中使用量显著减少,术后自主呼吸恢复时间、苏醒时间及拔管时间均显著缩短(P0.05),苏醒期躁动的发生率及躁动程度均较VICA组明显降低(P0.05),术后12、24 h切口疼痛的VAS评分均明显高于VICA组(P0.05)。结论:TIVA应用于腔镜下甲状腺手术可减少机体的应激反应和全麻药剂量,改善苏醒期质量,但应根据患者的疼痛感受采取必要的镇痛措施。

Influence of Total Intravenous Anesthesia on the Analgesia and Agitation for Thyroidectomy Micro Laparoscope

ABSTRACT Objective: To explore the postoperative analgesia effect of total intravenous anesthesia (TIVA) under laparoscopic surgery combined with ropivacaine and its influence on the recovery for general anesthesia. Methods: 74 cases of patients for thyroidectomy micro laparoscope were randomly divided into two groups: TIVA group(n=37), venous inhalation combined anesthesia(VICA) group (n=37). The levels of blood glucose(GLU), serum cortisol (COR), interleukin-6 (IL-6), stress response, dosage of anesthetic drugs, post- operative respiratory recovery time, waking time, extubation time, agitation after waking up, and postoperative analgesia effect were compared before anesthesia induction (T0), at 1 min after skin incision (T1), at 30 min after the onset of operation (T3), at the end of surgery (T3) and at 30 min after surgery (T4) between two groups. Results: At T1 time point, the related parameters of stress reaction in- cluding levels of GLU, COR, IL-6 in both groups were increased, and each index of TIVA group at T1~T4 time point were significantly lower than those in the VICA group (P<0.05). Compared with VICA group, the intraoperative dosage of propofol was significantly de- creased in TIVA group, the postoperative respiratory recovery time, recovery time and extubation time were significantly shortened (P<0.05). The incidence of agitation during waking up and degree of agitation were significantly decreased in TIVA group than those in VICA group (P<0.05). The VAS score of incision pain at 12 h, 24 h after operation in TIVA group were significantly higher than those in VICA group (P<0.05). Conclusion: TIVA for thyroidectomy micro laparoscope on analgesia and agitation can reduce the stress response and dosage of general anesthetics, improve the quality of awakening, but analgesia measures is needed according to patients'' pain.