【作者】 郑俊；

【导师】 杨东林；

【作者基本信息】 中南大学 ， 临床医学（专业学位）， 2023， 硕士

【摘要】 目的:阿芬太尼作为一种短效强阿片类镇痛药,较早应用于临床。本研究旨在评价胸腔镜肺癌根治术中使用阿芬太尼对疼痛情况、血流动力学状况、术后苏醒质量及不良事件发生率的影响。方法:采用随机数字表法将76例符合纳入和排除标准的患者分为对照组(38例)和实验组(38例)。对照组镇痛接受舒芬太尼0.3μg/kg诱导剂量和瑞芬太尼0.25μg/(Kg.min)维持输注,实验组镇痛接受阿芬太尼诱导剂量30μg/kg和维持剂量1μg/(Kg.min);用丙泊酚滴定以保持脑电双频指数(BIS)于40-60之间,其余麻醉药的使用两组一致。监测主要指标:术后6h、24h及48h的NRS评分、Ramsay评分及BCS评分;补救镇痛次数及人数;镇痛泵使用总药量。次要指标:血流动力学指标:入室时血压及心率(T1);双腔支气管插管时血压及心率(T2);进入胸腔时血压及心率(T3);拔管时血压及心率(T4);记录两组患者苏醒时的拔管时间及寒颤、躁动和嗜睡的发生率;不良反应恶心呕吐、头晕、瘙痒、尿潴留等不良反应发生率。结果:术后6h休息和咳嗽状态下组间比较实验组NRS评分低于对照组(P<0.05),且NRS评分>4分时对照组人数多于实验组(P<0.05)。术后6h BCS评分及Ramsay评分组间比较发现实验组评分大于对照组(P<0.05),舒适度更高。术后补救镇痛次数及人数与镇痛泵使用量两组相比无统计学差异。两组患者4个时间点的平均动脉压及心率比较无统计学差异。术中两组患者的升压药使用次数、降压药使用次数、最低平均动脉压、最高平均动脉压、阿托品使用次数、艾司洛尔使用次数、最低心率及最高心率比较无统计学意义。两组患者苏醒时寒颤、躁动、嗜睡等观测值进行比较无显著的统计学差异;术后拔管时间进行比较,P值为0.003,具有显著的统计学意义,且实验组平均拔管时间长于对照组。两组患者恶心呕吐、头晕、瘙痒、尿潴留等不良反应观测值进行比较,P值均大于0.05,无显著的统计学差异。结论:阿芬太尼可以安全的用于胸腔镜肺癌根治术患者的舒适化医疗中,可以明显改善患者术后6h的急性疼痛。但该镇痛药对患者长远的慢性疼痛发展的作用不明确。与常规麻醉方式相比,阿芬太尼可引起患者术后苏醒时间相对延长。苏醒的其他指标无显著差异,需要增大样本量进一步研究。图14幅,表18个,参考文献59篇更多还原

【Abstract】 PURPOSE: Alfentanil,a short-acting strong opioid analgesic,was used earlier in clinical practice.The aim of this study was to evaluate the effects of alfentanil use during radical thoracoscopic lung cancer surgery on pain profile,hemodynamic status,quality of postoperative awakening,and incidence of adverse events.METHODS: A random number table method was used to divide 76 patients who met the inclusion and exclusion criteria into a control group(38 patients)and an experimental group(38 patients).The control group received an induction dose of sufentanil 0.3 μg/kg and a maintenance infusion of remifentanil 0.25 μg/(kg.min).The experimental group received an induction dose of alfentanil 30 μg/kg and a maintenance dose of alfentanil 1 μg/(kg.min).propofol was titrated to maintain the electroencephalographic bifrequency index(BIS)between 40 and 60,and the rest of the anesthetics were used consistently in both groups.Primary indicators: NRS scores,Ramsay scores and BCS scores at 6h,24 h and48h postoperatively;number of remedial analgesia and number of people;total amount of analgesic pump used.Secondary indices: hemodynamic indices: blood pressure and heart rate at room entry(T1);blood pressure and heart rate at double-lumen bronchial intubation(T2);blood pressure and heart rate at chest entry(T3);blood pressure and heart rate at extubation(T4);recording the extubation time at awakening and the incidence of chills,agitation and drowsiness in both groups;the incidence of adverse reactions such as nausea and vomiting,dizziness,pruritus and urinary retention.RESULTS: The NRS score of the experimental group was lower than that of the control group in the inter-group comparison between rest and cough states at 6 h postoperatively(P < 0.05),and there were more people in the control group than in the experimental group when the NRS score was >4(P<0.05).Intra-group comparison between the experimental group at rest and in the coughing state revealed that the most pain was found at 24 h postoperatively,while the control group had the most pain at 6 h postoperatively when they were quiet and at 24 h postoperatively when they were coughing.Inter-group comparison of BCS score and Ramsay score at 6h postoperatively revealed that the experimental group had greater scores than the control group(P < 0.05)and higher comfort level.There was no statistical difference in the number of postoperative remedial analgesia visits and frequency compared with analgesic pump use.There was no statistical difference in MAP and heart rate between the two groups of patients at four time points.There were no statistically significant differences in the number of intraoperative ascending drug use,number of antihypertensive drug use,minimum MAP,maximum MAP,number of atropine use,esmolol use,minimum heart rate and maximum heart rate between the two groups.There was no statistically significant difference between the two groups when comparing the observed values of chills,agitation and drowsiness at awakening;when comparing the postoperative extubation time,the P value was 0.003,which was statistically significant,and the mean extubation time in the experimental group was longer than that in the control group.When comparing the observed values of adverse reactions such as nausea and vomiting,dizziness,pruritus and urinary retention in the two groups,the P value was greater than 0.05,and there was no statistically significant difference.CONCLUSION: Alfentanil can be safely used in the comfort care of patients undergoing thoracoscopic radical lung cancer surgery and can significantly improve acute pain in patients at 6h postoperatively.However,the effect of this analgesic on the development of long-term chronic pain in patients is unclear.Alfentanil caused prolonged postoperative awakening time in patients compared to conventional anesthesia.No significant differences in other indicators of awakening were observed,and further studies with larger sample sizes are needed.更多还原