摘要
目的探讨不同阿片类镇痛药对无痛胃镜检查患者术后疲劳综合征(postoperative fatigue syndrome, POFS)的影响。方法接受无痛胃镜检查的患者608例, 按随机数字表法分为对照组(C组, 201例)、瑞芬太尼组(R组, 198例)和布托啡诺组(B组, 209例)。C组静脉注射丙泊酚2.5 mg/kg行麻醉诱导, 静脉输注丙泊酚0.1 mg·kg^(-1)·min^(-1)术中维持;R组静脉注射丙泊酚2.0 mg/kg配伍瑞芬太尼0.5 μg/kg行麻醉诱导, 静脉输注丙泊酚0.1 mg·kg^(-1)·min^(-1)及瑞芬太尼0.05 μg·kg^(-1)·min^(-1)术中维持;B组静脉注射丙泊酚2.0 mg/kg配伍布托啡诺5 μg/kg行麻醉诱导, 静脉输注丙泊酚0.1 mg·kg^(-1)·min^(-1)术中维持。采用数字分级评分法(Numerical Rating Scales, NRS)评估患者症状(头晕、头昏、头痛、嗜睡、乏力)严重程度, 参考患者NRS评分, 采用Christensen疲劳评分量表评估患者疲劳评分并计算患者POFS评分;记录3组患者POFS评分、POFS发生率、POFS持续时间;记录"夜间入睡时症状仍存在, 第2天晨起后完全好转"的患者睡眠时长变化。结果 93%的患者POFS程度较轻(POFS评分1~4分);B组POFS评分高于C组(P<0.05);B组POFS发生率高于C组、R组(P<0.05);B组POFS持续时间长于C组、R组(P<0.05);"夜间入睡时症状仍存在, 第2天晨起后完全好转"的15例患者无痛胃镜检查当夜睡眠时长长于日常睡眠时长(P<0.05);其余指标差异无统计学意义(P>0.05)。结论不同阿片类镇痛药会对无痛胃镜检查患者POFS有不同影响, 布托啡诺等作用时间长的阿片受体激动-拮抗剂可能导致更严重的POFS;针对POFS的防治, 单纯丙泊酚和瑞芬太尼配伍丙泊酚是更为适宜的麻醉方案。
Objective To explore the effect of different opioid analgesics on postoperative fatigue syndrome(POFS)after pain⁃less gastroscopy.Methods A total of 608 patients who underwent painless gastroscopy were enrolled.According to the random num⁃ber table method,they were divided into three groups:a control group(group C,n=201),a remifentanil group(group R,n=198)and a butorphanol group(group B,n=209).Group C was intravenously injected with 2.5 mg/kg propofol for anesthesia induction,and main⁃tained by intravenous infusion of propofol at 0.1 mg·kg^(‒1)·min^(‒1).Group R was intravenously injected with 2.0 mg/kg propofol and 0.5μg/kg remifentanil for anesthesia induction,and maintained by intravenous infusion of propofol at 0.1 mg·kg^(‒1)·min^(‒1) and remifent⁃anil at 0.05μg·kg^(‒1)·min^(‒1).Group B was intravenously injected with 2.0 mg/kg propofol and 5μg/kg butorphanol for anesthesia induc⁃tion,and maintained by intravenous infusion of propofol at 0.1 mg·kg^(‒1)·min^(‒1).The severity of patient's symptoms,including dizziness,vertigo,headache,drowsiness,and fatigue,was evaluated by the Numerical Rating Scales(NRS).By reference to NRS scores,patient fa⁃tigue scores were evaluated by the Christensen Fatigues Scale and patient POFS scores were calculated.The incidence of POFS,POFS score and POFS duration in the three groups were recorded.Changes in sleep duration were recorded in patients with"symptoms still present at night but completely improved after morning rise the next day".Results POFS in 93% of patients was relatively mild(1‒4 points for POFS scores).Group B showed a higher POFS score than group C(P<0.05).The incidence of POFS in group B was higher than those in groups C and R(P<0.05),and the duration of POFS in group B was longer than those in groups C and R(P<0.05).The 15 patients whose"symptoms still existed when they fell asleep at night,and were completely improved when they woke up the next morn⁃ing"underwent painless gastroscopy and their sleep duration at night was longer than their daily sleep duration(P<0.05).There was no statistical difference in other indexes(P>0.05).Conclusions Different opioid analgesics exert different effects on POFS.Butorpha⁃nol and other opioid agonist⁃antagonists with long action time may cause more severe POFS.For the prevention of POFS,propofol alone and remifentanil combined with propofol are better anesthetic options.
作者
王丽卉
刘昕
董玉颖
高巨
Wang Lihui;Liu Xin;Dong Yuying;Gao Ju(Department of Anesthesiology,Clinical Medical College of Yangzhou University,Northern Jiangsu People's Hospital,Yangzhou 225001,China;Infectious Disease Prevention and Control Division of Center for Disease Control and Prevention of Yangzhou City,Yangzhou 225001,China)
出处
《国际麻醉学与复苏杂志》
CAS
2022年第4期341-344,共4页
International Journal of Anesthesiology and Resuscitation
基金
国家自然科学基金(81571936)
江苏省第五期"333高层次人才培养工程"中青年领军人才计划(2016-084)。
关键词
镇痛药
阿片类
胃镜检查术
术后疲劳综合征
麻醉
Analgesics,opioid
Gastroscopy
Postoperative fatigue syndrome
Anesthesia
