瞳孔测量指导非体外循环冠状动脉搭桥术术中阿片类药物使用

Pupillometry Guides Opioid Use during Off-Pump Coronary Artery Bypass Graft Surgery

摘要: 目的：本研究拟通过瞳孔测量指导非体外循环冠状动脉搭桥术术中阿片类药物使用，评估其术中使用的安全性和有效性。方法：择期非体外循环下冠状动脉搭桥术ASA分级II~III级患者60例，随机将60位患者分为对照组与实验组，每组30例。实验组采用手持式单目瞳孔计测量PD，根据PD变化调整舒芬太尼用量，对照组根据麻醉医生临床经验调整舒芬太尼用量。记录术中舒芬太尼、丙泊酚、艾司洛尔、尼卡地平和去甲肾上腺素总量、手术时间、麻醉时间；入手术室后麻醉前(T0)、切皮前2 min (T1)、切皮时(T2)、劈胸骨时(T3)、缝皮时(T4)记录HR、MAP、PD；手术结束至拔管时间、ICU时间、住院时间；苏醒后0 h、6 h、24 h、48 h VAS评分以及补充镇痛药物情况；恶心呕吐(PONV)、谵妄、慢性疼痛例数。结果：与对照组相比，实验组舒芬太尼用量减少(p < 0.05)、去甲肾上腺素使用减少(p < 0.05)、拔管时间缩短(p < 0.05)；PD组间比较T2、T3、T4实验组大于对照组，差异有统计学意义(p < 0.05)。结论：瞳孔测量指导非体外循环下冠状动脉搭桥术术中阿片类药物使用明显减少了术中阿片类用量，同时升压药物使用减少，拔管时间缩短，而术后VAS评分和不良反应未见增加。

Abstract: Objective: The purpose of this study was to evaluate the safety and efficacy of pupillometry monitoring opioid use during Off-pump coronary artery bypass graft surgery. Methods: Sixty patients, ASA grade II~III, who were scheduled for elective off-pump coronary artery bypass graft surgery, were randomly divided into observation group and control group, with 30 cases in each group. PD was measured by handheld monocular pupillometer in the experimental group, and the dosage of sufentanil was adjusted according to PD changes, while the dosage of sufentanil was adjusted according to the clinical experience of anesthesiologists in the control group. The total amount of sufentanil, propofol, esmolol, nicardipine and norepinephrine, operation time and anesthesia time were recorded. HR, MAP and PD were recorded before anesthesia (T0), 2 min before skin incision (T1), during skin incision (T2), breast bone splitting (T3) and skin suture (T4); Time from the end of surgery to extubation, ICU time and hospital stay; Scores of 0 h, 6 h, 24 h, 48 h VAS and supplemental analgesic drugs after recovery; nausea and vomiting (PONV), delirium, chronic pain cases. Results: Compared with the control group, the dosage of sufentanil in experimental group was decreased (p < 0.05), the use of norepinephrine was decreased (p < 0.05), and the extubation time was shortened (p < 0.05). Compared among PD groups, the T2, T3 and T4 experimental groups were larger than the control group, and the difference was statistically significant (p < 0.05). Conclusions: The use of opioids guided by pupil measurement during off-pump coronary artery bypass graft surgery significantly reduced the intraoperative opioid consumption, decreased the use of pressor drugs, and shortened the extubation time, while the postoperative VAS score and adverse reactions did not increase.