非阿片类镇痛复合静脉全麻在鼾症手术患者中的疗效

目的:观察三重措施预防为基础,联合非阿片镇痛药复合静脉全麻在行鼾症手术患者术后恶心呕吐的应用效果。方法:选择择期行鼾症手术男性病人80例,随机分为两组:吸入麻醉组(inhalation group, IHLA组)和静脉麻醉组(intravenous group, TIVA组),每组40例,两组均采用三重措施预防恶心呕吐,IHLA组采用以舒芬太尼为基础复合七氟烷吸入麻醉,TIVA组以氯胺酮和右美托咪定镇痛基础上丙泊酚全凭静脉麻醉。评估两组病人恶心呕吐危险系数,采用李克特量表(Likert scale),记录并分析两组患者术后6~8 h在麻醉后监测治疗室(post anesthesia care unit, PACU)及病房24 h恶心呕吐发生情况及补救用药用量。结果:两组患者一般临床资料、恶心呕吐风险评分、手术时间、术后恢复期补救用药量人数无显著差异(P>0.05);IHLA组在PACU恶心呕吐发生率为39.5%,TIVA组发生率为18.9%,两者相比有显著性差异(P<0.05);IHLA组病房24 h恶心呕吐严重程度高于TIVA组,两组术后需要补救应用抗呕吐药物用量无显著差异(P>0.05)。结论:以三重措施预防为基础,与吸入麻醉相比,非阿片类镇痛药复合静脉麻醉可以减少肥胖病人鼾症手术术后恶心呕吐发生率和严重程度,降低围术期风险,有利于患者早期恢复。

The Efficacy of Non-opioid Analgesic Combined Intravenous General Anesthesia in Patients with Snoring Surgery

ABSTRACT Objective: To observe the effect of triple measures prevention based on combined non opioid analgesia combined with intravenous anesthesia for postoperative nausea. Methods: Eighty male patients scheduled for snoring surgery under general anesthesia were randomly divided into inhalation group (IHLA)and intravenous group(TIVA). The two groups were administered with triple prophylaxis to prevent nausea and vomiting. Group inhalation was treated with sufentanil based compound seven halothane inhalation anesthesia. Group intravenous received ketamine and dexmedetomidine analgesia based on total intravenous anesthesia. The risk factors of nausea and vomiting were assessed in two groups. Likert scale was used to record the incidence of nausea and vomiting in post anesthesia care unit(PACU) and the ward and the dosage of remedial drugs of the two groups. Results: There was no significant difference between the two groups in general clinical data, risk score of nausea and vomiting, operation time and number of patients with remedial dosage in recovery period (P>0.05). Compared with the IHLA group, the incidence of nausea and vomiting in TIVA group was 18.9%, and there was significant difference between the two groups (P<0.05). The severity of nausea and vomiting in group IHLA was still higher than that in group TIVA, and there was no significant difference in the dosage of antiemetic drugs needed in the two groups after operation(P>0.05). Conclusion: On the basis of triple measures prevention, non opioid analgesics combined with intravenous anesthesia can reduce the incidence and severity of nausea and vomiting after the operation of snoring patients in obese patients, reduce perioperative risk, and facilitate early recovery of patients.