镇痛衔接预防全麻苏醒期躁动的临床研究

王玲+彭洪+匡显发+周兵+袁婉秋+杨文

【摘要】 目的：观察镇痛衔接对全麻苏醒期躁动的预防作用。方法：选取60例择期行全麻后腹部手术的患者，随机分为A、B、C三组；三组均行相同的麻醉处理，手术结束前10 min，A组静注芬太尼1 μg/kg，B组静注氟比洛芬酯1 mg/kg，C组患者不注入任何止痛药物；分别记录三组患者基础值、拔管前及拔管后5、10、30 min的MAP、HR值及血氧饱和度，记录拔管过程中咳嗽情况，拔管即刻、拔管后5、10、30 min的VAS评分及苏醒期SAS评分等数据进行对比研究。结果：三组间不同时刻的MAP、HR和SpO2值以及不同时刻的VAS評分和患者苏醒期SAS评分比较，差异均有统计学意义（P<0.05）；三组MAP、HR和SpO2值均随时间的延长而显著变化，VAS评分均随时间的延长而显著上升，差异均有统计学意义（P<0.01）；三组MAP、HR和SpO2值随时间的变化幅度比较，差异均有统计学意义（P<0.05），C组变化幅度明显大于A、B两组，且C组VAS评分、SAS评分以及苏醒期躁动发生率均显著高于A、B两组（P<0.05），C组患者拔管过程中容易出现持续咳嗽，患者镇痛效果较差，容易出现躁动。A、B两组间不同时刻的MAP、HR值、不同时刻的VAS评分、苏醒期SAS评分以及躁动发生率比较，差异均无统计学意义（P>0.05），拔管后5 min A组患者SpO2值显著低于B组（P<0.05），且A组患者咳嗽发生情况显著高于B组（P<0.05）。结论：将镇痛衔接理念应用于全麻苏醒期患者的预防，可以很好地减少躁动发生，有助于维持患者拔管过程中心率及血压稳定，氟比洛芬酯及芬太尼均可以实现良好的镇痛衔接效果，有效减少躁动发生，但氟比洛芬酯与芬太尼相比，对呼吸的抑制作用较小。

【关键词】 镇痛衔接； 苏醒期躁动； 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.