无阿片保留自主呼吸麻醉在手汗症日间手术中的应用

doi:10.3969/j.issn.1006-5725.2024.08.008

Abstract

Abstract:

Objective This study aime to investigate the clinical status of opioid free with spontaneous breathing anesthesia in the treatment of palmar hyperhidrosis through thoracic sympathectomy under thoracoscopy. Methods A total of 93 patients with palmar hyperhidrosis who underwent elective surgery with general anesthesia were randomly divided into control group （group C） and observation group （group O）. In group C， patients were treated with propofol， sufentanil， and cisatracurium. In group O， patients were anesthetized with propofol， dexmedetomidine， and thoracic paravertebral block. The changes of vital signs and blood gas indicators between two groups before anesthesia （T₁）， at the time of skin incision （T₂）， after surgery （T₃）， and leaving the operating room （T₄） were observed. The visual analog scale （VAS） of patients immediately after awakening （P₁）， leaving the operating room （P₂）， 2 hours （P₃）， 6 hours （P₄）， and 24 hours after surgery （P₅） were recorded. The occurrence of perioperative anesthesia related complications， postoperative recovery time and patients′ satisfaction were also observed. Results There was no case of surgical interruption due to anesthesia or anesthesia methods changing during the perioperative period. And no significant difference in the changes of sedation and pain index was observed between two groups （P > 0.05）. However， in group O， the VAS scores were higher at P₁ and P₄（P > 0.05）， PH was lower， PCO₂ and BG were higher at T₂ （P < 0.05）， and the incidence of perioperative hypertension and tachycardia was higher （P < 0.05）. There were no statistically significant difference in postoperative recovery time and patient′s satisfaction between these two groups （P > 0.05）. Conclusion The implementation of opioid free with spontaneous breathing anesthesia strategy in day surgery for palmar hyperhidrosis is safe and feasible but the application of this strategy has no significant advantages in clinical practice of day surgery.

Key words: palmar hyperhidrosis, opioid free anesthesia, spontaneous breathing, day surgery

CLC Number:

R614

Minqiang LIU,Fengzhu HONG,Shanshan GUO,Junyong HE,Xiaorui YANG,Qinlang SHI,Renliang HE,Qiang. WU. The application of opioid free with spontaneous breathing anesthesia in day surgery for palmar hyperhidrosis[J]. The Journal of Practical Medicine, 2024, 40(8): 1069-1073.

Figures/Tables 6

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References 15

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组别	例数	性别（例）		年龄（岁）	身高（cm）	体质量（kg）	手术时间（min）	手术方式（例）
组别	例数	男	女	年龄（岁）	身高（cm）	体质量（kg）	手术时间（min）	单侧	双侧
C组	45	19	26	25.4 ± 4.5	164.4 ± 7.1	56.2 ± 12.1	24.9 ± 13.0	26	19
O组	48	21	27	25.3 ± 5.5	163.6 ± 7.6	56.7 ± 12.1	23.6 ± 10.4	22	26
F/χ²值		0.022		1.514	0.496	0.155	0.636	1.330
P值		0.882		0.983	0.601	0.850	0.589	0.249

项目	组别	T₁	T₂	T₃	T₄	F值	P值
BIS	C组	95.5 ± 3.0	45.8 ± 7.0^##	55.4 ± 8.9^##	90.0 ± 6.9^##	695.706	0.000
	O组	95.2 ± 4.7	47.1 ± 9.2^##	58.0 ± 9.2^##	89.1 ± 4.7^##	398.210	0.000
F值		7.055	4.606	0.429	3.337
P值		0.707	0.451	0.159	0.471
PI	C组	76.4 ± 7.6	34.9 ± 9.0^##	36.7 ± 7.9^##	54.6 ± 11.1^##	457.164	0.000
	O组	79.4 ± 9.6	37.2 ± 12.4^##	38.6 ± 14.1^##	58.5 ± 15.1^##	155.547	0.000
F值		6.374	7.868	6.822	3.709
P值		0.094	0.311	0.407	0.157

组别	P₁	P₂	P₃	P₄	P₅	F值	P值
C组	0（0，0）	1（0， 1）^##	1.4 ± 0.6^##	1.4 ± 0.5^##	1（1， 1）^##	51.889	0.000
O组	1（0，1）^**	1（0， 2）^##	1.7 ± 0.7^##	1.8 ± 0.7^##*	1（0， 2）	41.545	0.000
F/Z值	-3.439	-1.926	0.273	0.682	-1.023
P值	0.001	0.054	0.066	0.010	0.306

项目	组别	T₁	T₂	T₃	T₄	F值	P值
pH值	C组	7.37 ± 0.03	7.39 ± 0.03^##	7.33 ± 0.05^##	7.34 ± 0.03^##	25.020	0.000
	O组	7.36 ± 0.02	7.37 ± 0.03^??	7.33 ± 0.03^##	7.34 ± 0.02^##	17.521	0.000
F值		1.216	0.029	0.732	3.800
P值		0.066	0.000	0.770	0.593
PCO₂ （mmHg）	C组	41.3 ± 3.2	38.9 ± 3.4^##	48.7 ± 8.4^##	44.4 ± 4.8^##	29.249	0.000
	O组	42.6 ± 3.9	42.6 ± 4.4^??	49.1 ± 7.3^##	45.5 ± 4.8^##	18.330	0.000
F值		1.318	3.340	0.432	0.362
P值		0.085	0.000	0.791	0.241
PO₂ （mmHg）	C组	46.7 ± 10.2	266.6 ± 85.0^##	199.7 ± 81.2^##	116.1 ± 57.2^##	106.467	0.000
	O组	48.0 ± 11.3	257.5 ± 82.9^##	196.6 ± 81.1^##	113.1 ± 42.4^##	120.674	0.000
F值		0.645	0.847	0.589	1.863
P值		0.546	0.603	0.854	0.778
BE［M（P₇₅，P₂₅）］	C组	0（-1， 1）	0（-1， 1）	1（0， 3）^##	1（0， 2）^#	4.673	0.007
	O组	0（-1， 1）	0（-1， 1）	1（-1， 2）	1（-1， 1）	2.606	0.063
F值/Z值		-0.361	-1.547	-1.423	-1.881
P值		0.718	0.122	0.155	0.060
HCO₃^- （mmol/L）	C组	24.4 ± 1.4	24.4 ± 2.1	26.5 ± 2.4^##	25.7 ± 1.8^##	10.315	0.000
	O组	24.9 ± 1.5	24.8 ± 1.8	26.7 ± 2.3^##	26.1 ± 1.7^##	8.916	0.000
F值		0.851	0.178	0.053	0.006
P值		0.089	0.334	0.623	0.307
BG （mmol/L）	C组	5.1 ± 0.7	5.2 ± 0.8	5.5 ± 1.2^#	5.4 ± 1.1	3.011	0.041
	O组	5.3 ± 0.8	5.5 ± 0.8^#?	5.4 ± 0.9	5.5 ± 0.8	3.997	0.013
F值		0.051	0.159	0.305	0.052
P值		0.151	0.044	0.827	0.659
Lac （mmol/L）	C组	1.1 ± 0.4	1.2 ± 0.4	1.2 ± 0.4	1.4 ± 0.6^#	3.728	0.018
	O组	1.1 ± 0.4	1.1 ± 0.4	1.1 ± 0.4	1.2 ± 0.4	2.489	0.072
F值		0.153	0.842	0.246	0.994
P值		0.659	0.414	0.204	0.058

组别	例数	低血压	高血压	心动过缓	心动过速	总不良反应
C组	45	25（55.6）	0（0.0）	13（28.9）	0（0.0）	38（84.5）
O组	48	21（43.8）	3（6.3）^*	7（14.6）	4（8.3）^*	35（73.0）
χ²值		1.298	4.062	2.844	5.460	1.855
P值		0.255	0.044	0.092	0.019	0.173

The application of opioid free with spontaneous breathing anesthesia in day surgery for palmar hyperhidrosis

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组别	丙泊酚用量（mg）	拔管时间（min）	定向力恢复时间（min）	留院时间（min）
C组	299.8 ± 85.1	7.0 ± 5.7	13.3 ± 6.6	4.9 ± 1.3
O组	300.7 ± 80.6	6.6 ± 4.0	13.5 ± 5.8	5.4 ± 1.3
F值	0.463	2.264	0.756	0.706
P值	0.961	0.700	0.832	0.082

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