Đánh giá hiệu quả giảm tiêu thụ opioid của phương pháp gây tê ngoài màng cứng khi phối hợp với gây mê toàn thân qua theo dõi ANI trong phẫu thuật ổ bụng

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Tác giả: Hữu Tú Nguyễn, Thị Quyên Vũ

Ngôn ngữ: vie

Ký hiệu phân loại: 615.781 Anesthetics

Thông tin xuất bản: Tạp chí Nghiên cứu y học (Đại học Y Hà Nội), 2022

Mô tả vật lý: 196-204

Bộ sưu tập: Metadata

ID: 500820

Thêm vào giỏ

Epidural analgesia has become a wide spread anesthetic technique for the perioperative treatment of patients undergoing major abdominal surgery and is one of the sparing-opioid anesthetic strategies. This study evaluated the effectiveness of reducing opioid consumption of epidural anesthesia combined with general anesthesia through the ANI (Analgesia Nociception Index) in patient undergoing major abdominal surgery. 60 patients undergone major abdominal surgery with ASA I and II voluntarily participated in this study. The patients were divided into two groups: group 1 (n = 30) received combined epidural analgesia with general anesthesia and group 2 (n = 30) received general anesthesia. We evaluated the effectiveness of intraoperative opioid savings and the quality of recovery of combined epidural analgesia with general anesthesia through ANI monitoring in patient undergoing major abdominal surgery. There was insignificant difference in age, weight, ASA classification and surgical duration. The amount of fentanyl/kg, the number of fentanyl reminders, and the total ANI time <
50 of the 2 groups were statistically significant with p <
0.05. The time to extubation from the end of surgery, the rate of nausea and vomiting in the recovery period (2 hours after surgery) were not statistically significant with p >
0.05. The mean VAS score of the 2 groups was 6.83 ± 1.45 in group 1 and 4.33 ± 0.216, the difference was statistically significant with p <
0.005. In both groups, no case of postoperative respiratory failure was recorded. In conclusion, combined epidural analgesia with general anesthesia is effective in reducing intraoperative opioid consumption and has a better quality of perception and pain relief compared to general anesthesia.Gây tê ngoài màng cứng (NMC) được dùng phổ biến trong giảm đau sau mổ các phẫu thuật ổ bụng lớn và là 1 trong những chiến lược gây mê tiết kiệm opioid (sparing- opiod). Nghiên cứu được thực hiện với mục đích đánh giá hiệu quả giảm tiêu thụ opioid của phương pháp gây tê NMC kết hợp gây mê toàn thân qua máy theo dõi độ đau ANI (Analgesia Nociception Index) trong phẫu thuật ổ bụng tại Bệnh viện Đại học Y Hà Nội. Nghiên cứu lâm sàng ngẫu nhiên có so sánh với 60 bệnh nhân được phẫu thuật lớn vùng bụng có ASA I,II, được phân thành 2 nhóm: Nhóm 1 (n = 30) kết hợp gây tê NMC với gây mê toàn thân và nhóm 2 (n = 30) gây mê toàn thân đơn thuần. Đánh giá hiệu quả tiết kiệm opioid trong mổ và chất lượng hồi tỉnh của phương pháp gây tê ngoài màng cứng phối hợp với gây mê toàn thân qua theo dõi ANI trong phẫu thuật ổ bụng. Kết quả nghiên cứu cho thấy không có sự khác biệt giữa 2 nhóm về độ tuổi, cân nặng, chiều cao, ASA, thời gian phẫu thuật. Lượng fentanyl/kg, số lần nhắc fentanyl, tổng thời gian ANI <
50 của 2 nhóm khác biệt có ý nghĩa thống kê với p <
0,05. Thời gian từ lúc mổ xong đến khi rút ống nội khí quản (NKQ), tỉ lệ buồn nôn và nôn trong giai đoạn hồi tỉnh không có sự khác biệt với p >
0,05. Tỉ lệ bệnh nhân tỉnh táo khi rút ống NKQ là 46,7% ở nhóm 1 và 73,3% ở nhóm 2, sự khác biệt này có ý nghĩa thống kê với p <
0,05. Điểm VAS trung bình của 2 nhóm lần lượt là 6,83 ± 1,45 ở nhóm 1 và 4,33 ± 0,216 ở nhóm 2, sự khác biệt có ý nghĩa thống kê với p <
0,05. Ở cả 2 nhóm không ghi nhận được trường hợp nào có suy hô hấp sau mổ. Chúng tôi đưa ra kết luận là kết hợp gây tê NMC với gây mê toàn thân có hiệu quả đáng kể trong việc giảm tiêu thụ opioid trong mổ, có chất lượng hồi tỉnh về tri giác và giảm đau tốt hơn so với gây mê đơn thuần sử dụng opioid.

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