持续输注艾司洛尔对腹腔镜胆囊切除术雷米芬太尼麻醉诱导后患者痛[摘要]目的?^察分析持续输注艾司洛尔对腹腔镜胆囊切除术雷米芬太尼麻醉诱导后患者痛觉过敏的影响。方法选取2015年2月～2016年4月于本院择期行腹腔镜胆囊切除术的88例患者，根据入院时间顺序分为研究组与对照组，每组44例。对照组患者于麻醉诱导前静脉注射生理盐水，持续输注至拔除气管导管即刻，研究组患者给予等量艾司洛尔持续输注。记录比较两组患者的体征变化、雷米芬太尼的用量和气管拔管时间及术后不良反应情况。结果对照组气管插管时（T1）、拔除气管导管时（T3）的平均动脉压与心率均明显高于麻醉诱导前（T0），差异有统计学意义（P<0.05）。研究组在T1、T3时的平均动脉压与心率均明显低于对照组，差异有统计学意义（P<0.05）。研究组在术后2、6、12、24h各个时间点的VSA评分均明显低于对照组，差异有统计学意义（P<0.05）。研究组的术中气管拔管时间和雷米芬太尼的用量明显少于对照组，差异有统计学意义（P<0.05）。研究组的术后恶心呕吐发生率（4.55%）明显低于对照组（25.00%），差异有统计学意义（P<0.05）。结论腹腔镜胆囊切除术患者围术期给予艾司洛尔可安全有效地减轻雷米芬太尼麻醉后诱发的痛觉过敏，减少术中雷米芬太尼的用量，维持患者血流动力学稳定，降低恶心呕吐发生率。[关键词]艾司洛尔；腹腔镜胆囊切除术；雷米芬太尼；痛觉过敏[]R614.2[文献标识码]A[]1674-4721（2017）11（b）-0108-04[Abstract]ObjectiveToobserveandanalyzetheeffectofcontinuousinfusionofEsmololonhyperalgesiainpatientsundergoinglaparoscopiccholecystectomyafterinductionofanesthesiawithRemifentanil.Methods88patientsundergoingelectivelaparoscopiccholecystectomyinourhospitalfromFebruary2015toApril2016wereselected.Accordingtotheadmissionorder，thepatientsweredividedintothestudygroupandthecontrolgroup，with44patientsineachgroup.Thepatientsinthecontrolgroupweregivenintravenousinjectionofnormalsalinebeforeinductionofanesthesiaandtheinfusionwascontinueduntiltheimmediatetimepointofremovingthetrachealtube.PatientsinthestudygroupweregivenequalamountsofEsmololforcontinuousinfusion.Thechangesofsigns，thedosageofRemifentanil，trachealextubationtimeandpostoperativeadversereactionswererecordedandcomparedbetweenthetwogroups.ResultsMAPandHRatthetimeoftrachealintubation（T1）andatthetimeofextubation（T3）weresignificantlyhigherthanthosebeforeanesthesiainduction（T0）inthecontrolgroup，withsignificantdifference（P<0.05）.TheMAPandHRinthestudygroupatT1andT3weresignificantlylowerthanthoseinthecontrolgroup，withsignificantdifference（P<0.05）.TheVSAscoresinthestudygroupat2，6，12，24haftersurgeryweresignificantlylowerthanthoseinthecontrolgroup，withsignificantdifference（P<0.05）.ThetimeoftrachealextubationandthedosageofRemifentanilinthestudygroupweresignificantlylowerthanthatinthecontrolgroup，withsignificantdifference（P<0.05）.Theincidencerateofpostoperativenauseaandvomitinginthestudygroupwas（4.55%），whichwassignificantlylowerthanthatinthecontrolgroup（25.00%），andthedifferencesweresignificant（P<0.05）.ConclusionPerioperativeadministrationofEsmololinthepatientsundergoinglaparoscopiccholecystectomycansafelyandeffectivelyreducethehyperalgesiainducedbyRemifentanilanesthesiainduction.ThedosageofRemifentanilisreducedintraoperatively，hemodynamicstabilityinpatientsismaintained，andtheincidencerateofnauseaandvomitingislowered.[Keywords]Esmolol；Laparoscopiccholecystectomy；Remif-entanil；Hyperalgesia有大量研究显示，阿片类药物在产生镇痛作用的同时，还可以诱发机体产生痛觉过敏和耐受[1-3]。雷米芬太尼是一种新型超短效的阿片类药物，由于其半衰期较短，可更...