舒芬太尼与瑞芬太尼各自复合丙泊酚静脉麻醉在腹腔镜 胆囊切除术的效果比较
| 作者: |
1陈仁军,
1沈学用,
1倪辉,
1刘敏,
1胡传才
1 安徽医科大学滁州临床学院 / 安徽省滁州市第一人民医院 麻醉科，安徽 滁州 239000 |
| 通讯: |
陈仁军
Email: czchenrenjun@126.com |
| DOI: | 10.3978/.2018.08.014 |
摘要
目的：比较腹腔镜胆囊切除术（LC）中采用舒芬太尼与瑞芬太尼各自复合丙泊酚静脉麻醉复合丙泊酚静脉麻醉的应用效果。
方法：纳入 2017 年 3 月―2018 年 3 月行 LC 的患者 90 例，随机均分为两组，分别行舒芬太尼复合丙泊酚麻醉（舒芬太尼组）与瑞芬太尼复合丙泊酚麻醉（瑞芬太尼组），比较两组麻醉各时间段的血流动力学指标与血清应激指标、自主呼吸恢复时间、睁眼时间和拔管时间、术后视觉模拟（VAS）评分、术前与术后的简易精神状态量表（MMSE）评分以及麻醉复苏期不良反应情况。
结果：与瑞芬太尼组比较，舒芬太尼组在麻醉诱导气管插管即刻、CO2 气腹后 5 min、拔管即刻的心率与平均动脉压、血清皮质醇与和去甲肾上腺素水平均明显降低（均 P<0.05）；自主呼吸恢复时间、睁眼时间和拔管时间均明显延长（均 P<0.05）；术后 2、6、12 h 的 VAS 评分均明显降低（均P<0.05）；术后 1 d 的 MMSE 评分明显升高（P<0.05）；总不良反应发生率明显降低（P<0.05）。
结论：相比瑞芬太尼复合丙泊酚麻醉，舒芬太尼复合丙泊酚静脉麻醉用于 LC 更有利于维持患者血流动力学稳定，应激反应更小，患者术后痛觉感受更轻，认知功能恢复更快，不良反应少。
关键词：
胆囊切除术，腹腔镜；麻醉药，联用；舒芬太尼
方法：纳入 2017 年 3 月―2018 年 3 月行 LC 的患者 90 例，随机均分为两组，分别行舒芬太尼复合丙泊酚麻醉（舒芬太尼组）与瑞芬太尼复合丙泊酚麻醉（瑞芬太尼组），比较两组麻醉各时间段的血流动力学指标与血清应激指标、自主呼吸恢复时间、睁眼时间和拔管时间、术后视觉模拟（VAS）评分、术前与术后的简易精神状态量表（MMSE）评分以及麻醉复苏期不良反应情况。
结果：与瑞芬太尼组比较，舒芬太尼组在麻醉诱导气管插管即刻、CO2 气腹后 5 min、拔管即刻的心率与平均动脉压、血清皮质醇与和去甲肾上腺素水平均明显降低（均 P<0.05）；自主呼吸恢复时间、睁眼时间和拔管时间均明显延长（均 P<0.05）；术后 2、6、12 h 的 VAS 评分均明显降低（均P<0.05）；术后 1 d 的 MMSE 评分明显升高（P<0.05）；总不良反应发生率明显降低（P<0.05）。
结论：相比瑞芬太尼复合丙泊酚麻醉，舒芬太尼复合丙泊酚静脉麻醉用于 LC 更有利于维持患者血流动力学稳定，应激反应更小，患者术后痛觉感受更轻，认知功能恢复更快，不良反应少。
Comparison of effects of sufentanil and remifentanil respectively combined with propofol for intravenous anesthesis in laparoscopic cholecystectomy
CorrespondingAuthor:CHEN Renjun Email: czchenrenjun@126.com
Abstract
Objective: To compare the effects of sufentanil and remifentanil respectively combined with propofol for intravenous anesthesia in laparoscopic cholecystectomy (LC).
Methods: Ninety patients undergoing LC from March 2017 to March 2018 were enrolled, equally randomized into two groups, and received intravenous anesthesia with sufentanil and propofol (sufentanil group) or remifentanil and propofol (remifentanil group). The hemodynamic parameters and serum stress indicators at predefined time points during anesthesia, times to recovery of spontaneous breathing, eye opening and extubation, scores of postoperative visual analogue scale (VAS), and pre- and postoperative scores of mini-mental state examination (MMSE) as well as incidence of adverse reactions were compared between the two groups.
Results: In sufentanil group compared with remifentanil group, the heart rate and mean arterial pressure as well as serum levels of cortisol and norepinephrine were significantly decreased at the moment immediately after tracheal intubation and anesthesia induction, 5 min after CO2 pneumoperitoneum, and the moment immediately after tube removal (all P<0.05); the times to recovery of spontaneous breathing, eye opening and extubation were all significantly prolonged (all P<0.05); the VAS scores were significantly decreased at 2, 6 and 12 h after operation (all P<0.05); the MMSE score on the first postoperative day was significantly increased (P<0.05); the overall incidence of adverse reactions was significantly reduced (P<0.05).
Conclusion: Compared to anesthesia using remifentanil combined with propofol, using sufentanil combined with propofol for LC is more helpful in maintaining the hemodynamic stability, weakening stress responses, lessening the severity of postoperative pain, quickening the recovery of cognitive function, and reducing the adverse reactions.
Keywords：
Cholecystectomy
Laparoscopic; Anesthetics
Combined; Sufentanil
Methods: Ninety patients undergoing LC from March 2017 to March 2018 were enrolled, equally randomized into two groups, and received intravenous anesthesia with sufentanil and propofol (sufentanil group) or remifentanil and propofol (remifentanil group). The hemodynamic parameters and serum stress indicators at predefined time points during anesthesia, times to recovery of spontaneous breathing, eye opening and extubation, scores of postoperative visual analogue scale (VAS), and pre- and postoperative scores of mini-mental state examination (MMSE) as well as incidence of adverse reactions were compared between the two groups.
Results: In sufentanil group compared with remifentanil group, the heart rate and mean arterial pressure as well as serum levels of cortisol and norepinephrine were significantly decreased at the moment immediately after tracheal intubation and anesthesia induction, 5 min after CO2 pneumoperitoneum, and the moment immediately after tube removal (all P<0.05); the times to recovery of spontaneous breathing, eye opening and extubation were all significantly prolonged (all P<0.05); the VAS scores were significantly decreased at 2, 6 and 12 h after operation (all P<0.05); the MMSE score on the first postoperative day was significantly increased (P<0.05); the overall incidence of adverse reactions was significantly reduced (P<0.05).
Conclusion: Compared to anesthesia using remifentanil combined with propofol, using sufentanil combined with propofol for LC is more helpful in maintaining the hemodynamic stability, weakening stress responses, lessening the severity of postoperative pain, quickening the recovery of cognitive function, and reducing the adverse reactions.