【罂粟摘要】脑功能图检查中应用小剂量瑞芬太尼输注对镇痛和止吐治疗需求的影响：一项回顾性队列研究

2021-08-10 09:07

脑功能图检查中应用小剂量瑞芬太尼输注对镇痛和止吐治疗需求的影响：一项回顾性队列研究贵州医科大学

脑功能图检查中应用小剂量瑞芬太尼输注对镇痛和止吐治疗需求的影响：一项回顾性队列研究

贵州医科大学　高鸿教授课题组

翻译：马艳燕　编辑：佟睿　审校：曹莹

背景

患者行清醒开颅手术时，清醒阶段的疼痛和不适应该得到缓解，以便于脑功能图的检测。虽然一些麻醉医师在这一阶段使用小剂量(0.01-0.05µg/kg/min)瑞芬太尼输注来镇痛，但其效果和副作用从未被评估过。因此，本研究的主要目的是研究小剂量瑞芬太尼输注对脑电图期间止吐治疗需求的影响，其次是确定小剂量瑞芬太尼输注对额外镇痛治疗需求的影响。

方法

这项回顾性研究包括从2008年到2018年在我中心接受清醒开颅手术的218名患者。观察苏醒期小剂量瑞芬太尼输注与镇痛或止吐治疗需求的关系。对患者和手术变量进行多变量回归分析。

结果

66例(30.3%)患者在清醒期行小剂量(中位数为0.01µg/kg/min)瑞芬太尼输注。49名患者(22.5%)接受了止吐治疗，99名患者(45.4%)接受了额外的止吐治疗。接受小剂量瑞芬太尼输注的患者与未接受瑞芬太尼输注的患者在额外止痛治疗方面没有显著差异(校正后的危险指数：1.13；95%CI：0.75-1.70；P=.570)；但是，接受瑞芬太尼的患者止吐药物的使用显著增加(校正后的危险指数：1.78；95%CI：1.01-3.15；P=0.047)。

结论

清醒开颅手术苏醒期小剂量瑞芬太尼输注显着增加了止吐药物的需求，但并未减少额外止痛治疗的需求。

原始文献来源

Shiraki A, Goto W, Fukagawa H, et al. Effects of low-dose remifentanil infusion on analgesic or antiemetic requirement during brain function mapping: A retrospective cohort study. Acta Anaesthesiol Scand. 2020 Jul;64(6):735-741.

英文摘要 Abstract

Effects of low-dose remifentanil infusion on analgesic or antiemetic requirement during brain function mapping: A retrospective cohort study

Abstract

Background: Pain and discomfort during the awake phase in awake craniotomy should be relieved to facilitate brain mapping. Although some anaesthesiologists use low-dose (0.01-0.05 µg/kg/min) remifentanil infusion to provide analgesia during this phase, its efficacy and side effects have never been evaluated. Therefore, this study primarily aimed to investigate the effects of low-dose remifentanil infusion on the need for antiemetic treatment during brain mapping and secondarily aimed to determine its effects on the need for additional analgesic treatment.

Methods: This retrospective study included 218 patients who underwent awake craniotomy at our centre from 2008 to 2018. The relationship between low-dose remifentanil infusion during the awake phase and the requirement for analgesic or antiemetic treatment was examined. A multivariable competing risk regression analysis was performed to adjust for patient and operative variables.

Results: Sixty-six patients (30.3%) received low-dose (median rate: 0.01 µg/kg/min) remifentanil infusion during the awake phase. Forty-nine patients (22.5%) received an antiemetic and 99 (45.4%) received additional analgesic treatment. The difference in additional analgesic treatment was not significant between patients who received low-dose remifentanil infusion and those who did not (adjusted hazard ratio: 1.13; 95% confidence interval: 0.75-1.70; P = .570); however, the use of antiemetics significantly increased in patients who received remifentanil (adjusted hazard ratio: 1.78; 95% confidence interval: 1.01-3.15; P = .047).

Conclusion: Low-dose remifentanil infusion during the awake phase in awake craniotomy significantly increased the need for antiemetics but did not decrease the need for additional analgesic treatment.