基础医学与临床 ›› 2015, Vol. 35 ›› Issue (10): 1341-1345.

• 研究论文 • 上一篇    下一篇

镇痛/伤害性刺激指数指导瑞芬太尼在全麻腰椎后路手术中的应用

易端,魏滨,张利萍,郭向阳   

  1. 北京大学第三医院
  • 收稿日期:2015-05-25 修回日期:2015-07-08 出版日期:2015-10-05 发布日期:2015-09-30
  • 通讯作者: 张利萍 E-mail:lipingzhang01@yahoo.com.cn
  • 基金资助:
    北京大学第三医院临床重点项目

Analgesia nociception index guided remifentanil administration during general anesthesia in posterior lumbar spinal surgery

  • Received:2015-05-25 Revised:2015-07-08 Online:2015-10-05 Published:2015-09-30
  • Contact: ZHANG Li-ping E-mail:lipingzhang01@yahoo.com.cn

摘要: 目的 评估镇痛/伤害性指数(ANI)指导瑞芬太尼在全麻腰椎后路手术中应用的可行性。方法 将60例择期行后路腰椎椎板切除减压内固定术的患者随机分入ANI组或对照组,均采用瑞芬太尼-丙泊酚靶控输注,ANI组根据ANI值(50~70)调整瑞芬太尼靶浓度,而对照组根据心率、血压等调整。记录麻醉药物使用量、术中不希望事件(高血压、低血压、心动过速、心动过缓和体动反应)发生次数及干预措施(阿托品、麻黄素、艾司洛尔、乌拉地尔和快速扩容等)使用情况,记录苏醒时间及疼痛评分,有无术中知晓、恶心呕吐等。结果 与对照组比较,ANI组瑞芬太尼用量、低血压和心动过缓发生次数下降(P<0.05),乌拉地尔使用次数增加而快速扩容次数减少(P<0.05),其余指标两组比较无差异。结论 在全麻腰椎后路手术中,应用ANI指导麻醉可以减少瑞芬太尼用量,术中血流动力学更加平稳。

关键词: 镇痛/伤害性刺激指数, 心率变异性, 脑电双频谱指数, 全身麻醉

Abstract: Objective To evaluate the clinical profile of ANI-guided remifentanil administration during posterior lumbar spinal surgery. Methods 60 patients undergoing selective posterior lumbar decompression laminectomy and internal fixation were randomized into two groups, ANI-guided analgesia group (ANI group) and another group which was blinded to ANI (control group).In both groups, combined propofol-remifentanil target control infusion(TCI) were performed, In ANI group, the concentration of remifentanil was adjusted to maintain ANI values between 50 and 70, however, in the control group, remifentanil target concentration was adapted corresponding to HR or BP values. Anesthetics consumption, incidence of unwanted events, interventions, time of open-eyes and extubation, VAS0h and VAS1/2h, complementary analgesics, intraoperative awareness, PONV and other symptoms were recorded. Results Remifentanil consumption was lower in ANI group than that in control group (P<0.05).The number of unwanted events(hypotension, bradycardia and total unwanted events ) were also less in ANI group than that in control group (P<0.05). Compared with control group, the usage of urapidil was more and the usage of volume expansion was less in ANI group(P<0.05). There were no significant statistic differences in other index between two groups. Conclusion ANI-guided remifentanil infusion resulted in lower remifentanil administered dose and more stable hemodynamics in posterior lumbar spinal surgery.

Key words: analgesia nociception index, heart rate variability, bispectral index, general anesthesia

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