laparoscopic袖子胃切除术的多式和手术内阿片类药物免费麻醉之间的比较:一个前性随机化研究
Piotr Mieszczański1,2, Grzegorz Górniewski3,4, Paweł Ziemiański4,5
11st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warszawa, Poland. piotr.mieszczanski@gmail.com.
Scientific reports
|August 4, 2023
概括
无阿片类药物麻醉 (OFA) 显示在腹腔镜袖子胃切除术后减少疼痛和恶心的早期好处,但需要更密切的血液动力学监测. 多种模式止痛 (MMA) 与雷米芬坦尼尔输液在24小时内没有显示出整体疼痛或阿片类药物使用的显著差异.
科学领域:
- 麻醉学 麻醉学
- 腹部外科 腹部外科
- 疼痛管理 疼痛管理
背景情况:
- laparoscopic袖子胃切除术麻醉带来了一些挑战.
- 无阿片类麻醉 (OFA) 显示了潜在的益处,但最佳技术缺乏共识.
- 使用雷米芬坦尼尔的多模式止痛 (MMA) 是一个常见的替代方案.
研究的目的:
- 为了比较手术内OFA与MMA使用Remifentanil输液进行腹腔镜袖胃切除术.
- 评估每个麻醉方法的好处和风险.
- 评估术后疼痛,阿片类药物消耗和其他术后结果.
主要方法:
- 对59名接受腹腔镜袖子胃切除术的患者进行前性随机研究.
- 与Remifentanil输注的OFA与MMA的比较.
- 主要结局:手术后1,6,12和24小时的氧化消耗和疼痛评分 (NRS).
主要成果:
- 两组之间整体24小时疼痛评分或氧化需求没有显著差异.
- 在手术后的第一小时内,OFA组显示氧化的使用减少 (4.6毫克与7.72毫克相比) 和较低的PONV影响量表 (p<0.05).
- OFA组需要更高的以弗德林剂量 (23.67毫克 vs. 15.69毫克) 和更多的静脉注射液 (1160毫升 vs. 925.86毫升).
结论:
- OFA提供了早期的阿片类药物节约作用,并在腹腔镜袖子胃切除术后的第一个小时内减少术后恶心和吐 (PONV).
- 然而,OFA与更大的血液动力学可变性有关,需要增加血管压缩剂和液体的管理.
- 无论是OFA还是MMA都没有显示出整体24小时疼痛或阿片类药物消费的显著差异.
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