氟比洛芬酯联合地佐辛超前镇痛对肥胖患者腔镜术后拔管期血流动力学的影响

摘要

目的 探讨氟比洛芬酯联合地佐辛超前镇痛对肥胖患者腔镜术后拔管期血流动力学的影响.方法 选取新疆维吾尔自治区人民医院择期行腹腔镜胆囊切除术的汉族肥胖女性患者225例,完全随机分为地佐辛组(D组)、氟比洛芬酯组(F组)和氟比洛芬酯联合地佐辛(DF组),每组75例.患者均行全身麻醉,麻醉诱导前15 min,D组静脉给予地佐辛0.1 mg/kg;F组静脉给予氟比洛芬酯1 mg/kg;DF组静脉给予地佐辛0.1 mg/kg和氟比洛芬酯1 mg/kg.分别记录手术前(基础值,T0)、缝皮结束时(T1)、拔管即刻(T2)、拔管后5 min(T3)、10 min(T4)的平均动脉压(MAP)、心率及术后拔管时效指标(自主呼吸恢复时间、睁眼时间、拔管时间)及拔管期不良反应发生情况.结果 3组患者年龄、体重指数、手术时间、拔管时效指标差异均无统计学意义(均P ＞0.05).3组患者在T0及T4时的MAP、心率差异均无统计学意义(均P＞0.05);DF组T1、T2、T3时MAP、心率低于F组[MAP:(91±5)mmHg比(96±5)mmHg、(93±9)mmHg比(98±11)mmHg、(93±6)mmHg比(98 ±6) mmHg,心率:(82±5)次/min比(85±2)次/min、(86±8)次/min比(92±6)次/min、(85 ±-3)次/min比(87±3)次/min],T2、T3时MAP、心率低于D组[(99±6)、(98±9)mmHg(1 mmHg =0.133 kPa),(91±3)、(88±2)次/min],差异均有统计学意义(均P＜0.05).3组患者不良反应发生率差异无统计学意义(P＞0.05).结论 氟比洛芬酯联合地佐辛超前镇痛能有效抑制肥胖患者拔管期的血流动力学波动,提高肥胖患者的苏醒质量,优于单一用药.%Objective To investigate the effect of preemptive analgesia with flurbiprofen axetil combined with dezocine on hemodynamics during tracheal extubation period in obese patients.Methods Totally 225 obese women of Han nationality who had laparoscopic cholecystectomy under general anesthesia in People's Hospital of Xinjiang Uygur Autonomous Region were randomly divided into dezocine group(D group),flurbiprofen axetil group(F group) and flurbiprofen axetil combined with dezocine group(DF group),with 75 cases in each group.At 15 min before anesthesia induction,D group was intravenously administered dezocine 0.1 mg/kg;F group was intravenously administered flurbiprofen axetil 1 mg/kg;DF group was intravenously administered dezocine 0.1 mg/kg and flurbiprofen axetil 1 mg/kg.Mean arterial pressure(MAP) and heart rate(HR) were recorded before operation (baseline,T0),at the end of seaming (T1),during extubation (T2),5 min after extubation (T3) and 10 min after extubation (T4).Spontaneous breathing recovery time,eye opening time,extubation time and extubation related adverse reactions were recorded.Results There were no significant differences of age,body mass index,operation time,spontaneous breathing recovery time,eye opening time and extubation time among groups(P ＞ 0.05).MAP and HR showed no significant differences among groups at T0 and T4 (P ＞ 0.05).MAP and HR at T1,T2,T3 in DF group were significantly lower than those in F group [MAP:(91 ±5)mmHgvs (96±5)mmHg,(93±9)mmHgvs (98±11)mmHg,(93±6)mmHgvs (98± 6)mmHg;HR:(82 ±5)times/min vs (85 ±2)times/min,(86 ±8)times/min vs (92 ±6)times/min,(85 ± 3) times/min vs (87 ± 3) times/min];MAP and HR at T2,T3 in DF group were significantly lower than those in D group [(99 ± 6),(98 ± 9) mmHg;(91 ± 3),(88 ± 2) times/min] (all P ＜ 0.05).There was no significant difference of adverse reaction incidence among groups (P ＞ 0.05).Conclusion Preemptive analgesia with flurbiprofen axetil combined with dezocine can effectively inhibit hemodynamic fluctuations in obese patients during extubation period and improve the recovery quality.