文章摘要

还原型谷胱甘肽与纳洛酮多模式催醒方案对肝病患者麻醉苏醒期的影响

作者: 1张梦琪, 1张睿, 1马晓雨, 1张雅珊, 1宋春雨
1 哈尔滨医科大学附属第二医院麻醉科,哈尔滨 150086
通讯: 宋春雨 Email: scy-zw@163.com
DOI: 10.3978/j.issn.2095-6959.2020.06.007

摘要

目的:探讨还原型谷胱甘肽(GSH)结合纳洛酮对于肝病患者麻醉苏醒的时间及质量的影响。方法:选取2017年9月只2018年12月于哈尔滨医科大学附属第二医院进行手术治疗的肝病患者84例,随机分成3组。A组采用纳洛酮注射液0.01 mg/kg于术终静脉注射;B组在A组基础上,给予GSH注射剂1.2 g,添加到10%葡萄糖溶液100 mL静脉滴注,在手术结束前0.5 h内滴完;C组不给予催醒剂作为空白对照组。记录患者自主呼吸恢复时间、睁眼时间、拔管时间、苏醒期拔管质量评分、躁动评分(RS评分)、镇静评分(Ramsay评分)、手术时间、麻醉时间、术中补液量及尿量。分别记录患者清醒后、给予纳洛酮后30 min和60 min的VRS疼痛评分,术前、术后1 d患者的肝功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)]。结果:与C组比较,A组、B组的拔管质量评分、RS评分下降,Ramsay评分增高(P<0.01)。与A组比较,B组拔管质量评分、RS评分下降,Ramsay评分增高(P<0.05)。与C组比较,A,B两组患者的呼吸恢复时间、苏醒时间和拔管时间均缩短(P<0.01)。与A组比较,B组患者的呼吸恢复时间、苏醒时间、拔管时间缩短(P<0.05)。术后1 d,3组患者肝功能差异无统计学意义。结论:GSH联合纳洛酮可以减少肝病患者术后麻醉苏醒时间,提高肝病患者术后麻醉苏醒质量,并不增加患者术后疼痛评分。
关键词: 还原型谷胱甘肽;纳洛酮;肝病患者;麻醉苏醒

Effects of reduced glutathione and naloxone multimodal wake-up regimen on anesthesia recovery in patients with liver disease

Authors: 1ZHANG Mengqi, 1ZHANG Rui, 1MA Xiaoyu, 1ZHANG Yashan, 1SONG Chunyu
1 Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China

CorrespondingAuthor: SONG Chunyu Email: scy-zw@163.com

DOI: 10.3978/j.issn.2095-6959.2020.06.007

Abstract

Objective: To investigate the effect of reduced glutathione combined with naloxone on the time and quality of anesthesia recovery in patients with liver disease. Methods: Eighty-four patients with liver disease who underwent surgery in our hospital from September 2017 to December 2018 were randomly divided into three groups. Group A was treated with naloxone injection 0.01 mg/kg in the final intravenous bolus, Group B was given a reduced glutathione injection of 1.2 g based on group A, and was added to 10% glucose solution 100 mL intravenous drip was dripped within half an hour before the end of the operation. Group C did not give wake agent as a blank control group. The recovery time of spontaneous breathing, eye opening time, extubation time, extubation quality score, agitation score (RS score), sedation score (Ramsay score), operation time, anesthesia time, intraoperative fluid and urine volume were recorded. VRS pain scores were recorded after awakening and 30 min and 60 min after naloxone administration, as well as liver function (ALT and AST) before and 1 d after surgery. Results: Compared with group C, the extubation quality score and RS score of group A and group B decreased, and the Ramsay score increased (P<0.01). Compared with group A, group B had lower extubation quality score, RS score, and Ramsay score increased (P<0.05). Compared with group C, the respiratory recovery time, recovery time and extubation time of patients in group A and group B were shortened (P<0.01). Compared with group A, the respiratory recovery time, recovery time, and extubation time of group B patients were shortened (P<0.05). Conclusion: Reduced glutathione combined with naloxone can reduce the postoperative anesthesia recovery time of patients with liver disease and improve the quality of postoperative anesthesia recovery in patients with liver disease, and does not increase the postoperative pain score.
Keywords: reduced glutathione; naloxone; liver disease patient; anesthesia recovery

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