评价镇痛-伤害性刺激指数（ANI）指导下无阿片类药物麻醉对腔镜下甲状腺手术患者术后恢复质量的影响。

选择2023年3月至12月中南大学湘雅医学院附属常德医院择期行腔镜下甲状腺手术患者120例，均为女性，年龄18~65岁，体质指数18.5~28 kg/m²，ASA Ⅰ~Ⅱ级。按随机数字表法分为无阿片类药物麻醉组（OFA组）和对照组（C组），每组60例。OFA组采用艾司氯胺酮、右美托咪定、丙泊酚、罗库溴铵麻醉诱导，艾司氯胺酮、右美托咪定、丙泊酚维持；C组采用舒芬太尼、丙泊酚、罗库溴铵诱导，瑞芬太尼、丙泊酚维持；根据脑电双频指数（BIS）和ANI调整麻醉药物剂量，维持BIS 40~60，ANI 50~70。于术前1 d（D_-1）、术后1 d（D₁）采用15项恢复质量量表（QoR-15）评估患者恢复质量，记录麻醉诱导前（T₀）、气管插管前（T₁）、气管插管后即刻（T₂）、切皮时（T₃）、气管导管拔除后即刻（T₄）、气管导管拔除后10 min（T₅）HR、MAP、SpO₂、BIS、ANI；记录手术时间、拔管时间、恢复室停留时间、术后首次肛门排气时间、首次下床活动时间和术后住院时间，术后2、6、24 h NRS疼痛评分，围手术期不良反应发生情况。

与D_-1比较，两组患者D₁时QoR-15评分都有下降（P<0.05）；与C组比较，OFA组D₁时QoR-15评分较高（QoR-15总分：t=17.503，P<0.001），术后首次肛门排气时间、术后首次下床活动时间较短，术后恶心呕吐发生率较低，满意度较高（均P<0.05）。HR在T_1-3时较快（均P<0.001），MAP在T_1-3时较高（均P<0.001），SpO₂在T₄时较低、T₅时较高，BIS在T_1-3时较高，ANI在T_1-3时较低、T_4-5时较高。两组患者手术时间、拔管时间、恢复室停留时间、术后住院时间、术后2、6、24 h NRS疼痛评分及其他围手术期不良反应发生率差异无统计学意义。

OFA能缩短腔镜下甲状腺手术患者术后首次肛门排气时间和下床活动时间，减少术后恶心呕吐发生率，改善术后恢复质量。

To evaluate the effect of opioid-free anesthesia (OFA) under the guidance of analgesia-nociception index (ANI) on the postoperative recovery quality of patients undergoing laparoscopic thyroid surgery.

A total of 120 female patients aged 18-65 years, with BMI of 18.5-28 kg/m² and ASA grade Ⅰ-Ⅱ, who underwent elective endoscopic thyroid surgery at Changde Hospital, Xiangya School of Medine, Central South University from March to December 2023 were selected. They were divided into OFA group and control group (C group) using a random number table method, with 60 cases in each group. The OFA group was induced by anesthesia with esketamine, dexmedetomidine, propofol, and rocuronium bromide, while esketamine, dexmedetomidine, and propofol were maintained; Group C was induced with sufentanil, propofol, and rocuronium bromide, while maintained with remifentanil and propofol. The dosage of anesthetic drugs was adjusted based on the bispectral index (BIS) and ANI, maintaining BIS 40-60 and ANI 50-70. The 15-item quality of recovery (QoR-15) was used to evaluate the patients’ recovery quality 1 day before (D_-1) and 1 day after surgery (D₁). The following data were recorded of HR, MAP, SpO₂, BIS, and ANI before anesthesia induction (T₀), before tracheal intubation (T₁), immediately after tracheal intubation (T₂), at skin incision (T₃), immediately after tracheal intubation (T₄), and 10 minutes after tracheal intubation (T₅). The surgical time, extubation time, recovery room stay time, first postoperative anal exhaust time, first postoperative out-of-bed activity time, and postoperative hospitalization stay were recorded. The numeric rating scale (NRS) scores at the 2nd, 6th, and 24th hour after surgery, the occurrence of perioperative adverse reactions (bradycardia, hypotension, nausea and vomiting, dizziness) and patient satisfaction were recorded.

Compared with D_-1, both groups of patients showed a decrease in QoR-15 scores on D₁ (P<0.05). Compared with Group C, the OFA group had a higher QoR-15 score on D₁ (QoR-15 total score: t=17.503, P<0.001), earlier first postoperative anal exhaust time, earlier first postoperative out-of-bed time, lower incidence of postoperative nausea and vomiting, and higher patient satisfaction (all P<0.05). HR was faster at T_1-3, MAP was higher at T_1-3 (all P<0.05). SpO₂ was lower at T₄, higher at T₅. BIS was higher at T_1-3. ANI was lower at T_1-3, higher at T_4-5. There were no statistically significant differences in surgical time, extubation time, recovery room stay time, postoperative hospitalization time, postoperative NRS pain scores at the 2nd, 6th, and 24th hour and the incidence of other perioperative adverse reactions between the two groups of patients.

OFA can advance the first anal exhaust time and ambulation time, reduce the incidence of postoperative nausea and vomiting, and improve the quality of postoperative recovery in patients after laparoscopic thyroid surgery.