丙泊酚全凭静脉麻醉对玻璃体切除术患者当天术后恢复质量的随机 对照研究

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Patient quality of recovery on the day of surgery after propofol total intravenous anesthesia for vitrectomy

背景与目的

全麻下⾏玻璃体切除是⼀种常⻅的⽇间⼿术。选择⼀种术后恢复质量较⾼的麻醉⽅法是成功⽇间⼿术的必然选择。本研究选择丙泊酚全凭静脉麻醉(丙泊酚组)和地氟醚吸⼊麻醉(地氟醚组)为两种有代表性的麻醉⽅法,采⽤质量恢复问卷QoR-40 对玻璃体切除术患者当天的术后恢复质量进⾏评价。

方  法

将84例(20~80岁)在全麻下⾏择期玻璃体切除术患者随机分为2组。丙泊酚组采⽤效应室靶控输注丙泊酚和瑞芬太尼,地氟醚组吸⼊地氟醚和效应室靶控输注瑞芬太尼。采⽤QoR-40调查问卷评估患者术后6h恢复质量。此外,我们还收集了患者麻醉苏醒和恢复期间与恢复和并发症相关的数据。

结  果

丙泊酚组⼿术当天QOR-40评分中位数明显⾼于地氟醚组(分别为181.0vs169.5,p=0.033)。特别是丙泊酚组的身体舒适度和身体独⽴维度得分显著⾼于地氟醚组。与地氟醚组相⽐,丙泊酚组瑞芬太尼⽤量明显增加,苏醒时间明显延⻓。然⽽,两组患者在其他并发症⽅⾯并⽆显著性差异。

结  论

使⽤丙泊酚全凭静脉麻醉在⼿术当天患者的恢复质量明显优于地氟醚吸⼊麻醉。

原始文献摘要

Na SH, Jeong KH, Eum D, et al. Patient quality of recovery on the day of surgery after propofol total intravenous anesthesia for vitrectomy: A randomized controlled trial[J]. Medicine (Baltimore) 2018 Oct

Background: Vitrectomy under general anesthesia is considered as a candidate for ambulatory surgery. An anesthetic method with high quality of postoperative recovery should be selected for successful ambulatory surgery. We thus compared quality of postoperative recovery on the day of vitrectomy using the Quality of Recovery (QoR)-40 questionnaire between propofol total intravenous anesthesia (propofol group) and desflurane inhalation anesthesia (desflurane group) as the 2 representative anesthetic methods.

Methods: Eighty-four patients (20–80 years old) undergoing elective vitrectomy under general anesthesia were randomized into 2 groups. The propofol group received propofol and remifentanil using effect�site target-controlled infusion (TCI), and the desflurane group received desflurane inhalation and remifentanil using effect-site TCI. We assessed quality of recovery at 6 hours after surgery through interviews using the QoR-40 questionnaire. We also collected data related to recovery and complications during emergence and recovery period.

Results: The median of QoR-40 score on the day of surgery was significantly higher in the propofol group than that in the desfluranegroup (181.0 vs 169.5, respectively; P=.033). In particular, propofol group had significantly higher scores for physical comfort and physical independence dimensions. The amount of remifentanil administered was significantly higher, and the emergence time was significantly longer in propofol group. However, there were no significant differences in other complications between the 2 groups.

Conclusions: Propofol total intravenous anesthesia provided significantly better quality of recovery on the day of surgery than desflurane inhalation anesthesia.

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贵州医科大学高鸿教授课题组

编辑:代东君   审校:符校魁

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