舒芬太尼联合瑞芬太尼全身麻醉对行腹部手术的高龄患者血流动力学、应激反应及镇痛效果的影响

摘要

OBJECTIVE:To explore the effects of sufentanil combined with remifentanil on the hemodynamics,stress re-sponse and analgesic effect of elderly patients with abdominal surgery by general anesthesia. METHODS:170 elderly patients with abdominal surgery by general anesthesia were randomly divided into control group and observation group,85 cases in each group. All patients received general anesthesia. Control group induced anesthesia by 4 ng/kg remifentanil and maintained by 5 ng/kg;obser-vation group induced anesthesia by 3 ng/kg sufentanil and 2 ng/kg remifentanil,maintained by 0.15 mg/(kg·h)remifentanil and 3 ng/kg remifentanil. Heart rate(HR)and mean arterial pressure(MAP)before anesthesia induction,immediately intubation,1 min after intubation,abdominal entry and 1 min after extubation,norepinephrine and epinephrine levels before anesthesia induction,1 min after intubation,1 min after extubation,6 and 12 h after surgery in 2 groups were observed,restlessness and alertness/seda-tion scores after extubation,6,12,24 h postoperative visual analogue scede (VAS) score and the incidence of adverse reactions were compared. RESULTS:HR and MAP levels in 2 groups immediately intubation,1 min after intubation,abdominal entry and 1 min after extubation significantly changed,HR and MAP levels in observation group 1 min after intubation,abdominal entry and 1 min after extubation were significantly lower than control group,the differences were statistically significant(P<0.05);nor-epinephrine and epinephrine levels in 2 groups 1 min after intubation,1 min after extubation,6 and 12 h after surgery significant-ly changed,and observation group was lower than control group,the differences were statistically significant(P<0.05);restless-ness and alertness/sedation scores after extubation,6,12,24 h VAS score in observation group were significantly lower than con-trol group,the differences were statistically significant(P<0.05). There was no significant difference in the incidence of adverse reactions between 2 groups (P>0.05). CONCLUSIONS:Sufentanil combined with remifentanil can effectively stabilize hemody-namics of elderly patients with abdominal surgery,reduce the stress response levels and improve the postoperative analgesic ef-fect,with good safety.%目的：探讨舒芬太尼联合瑞芬太尼全身麻醉对行腹部手术的高龄患者血流动力学、应激反应及镇痛效果的影响。方法：选取择期行全身麻醉腹部手术的高龄患者170例，按随机数字表法分为对照组和观察组，各85例。两组患者均行全身麻醉。对照组患者采用瑞芬太尼4 ng/kg行麻醉诱导，5 ng/kg行麻醉维持；观察组患者则经镇痛泵给予舒芬太尼3 ng/kg和瑞芬太尼2 ng/kg行麻醉诱导，舒芬太尼0.15 mg/（kg·h）和瑞芬太尼3 ng/kg行麻醉维持。观察两组患者麻醉诱导前、插管即刻、插管后1 min、进腹时、拔管后1 min的心率（HR）、平均动脉压（MAP）与麻醉诱导前、插管后1 min、拔管后1 min、术后6及12 h的去甲肾上腺素和肾上腺素水平，并比较拔管后躁动评分、警觉/镇静评分，术后6、12、24 h视觉模拟（VAS）评分及不良反应发生情况。结果：两组患者插管即刻、插管后1 min、进腹时及拔管后1 min的HR、MAP水平均显著改变，且观察组患者插管后1 min、进腹时及拔管后1 min时点的HR、MAP水平均显著低于对照组，差异均有统计学意义（P＜0.05）；两组患者插管后1 min、拔管后1 min、术后6及12 h的去甲肾上腺素和肾上腺素水平均显著改变，且观察组显著低于对照组，差异均有统计学意义（P＜0.05）；观察组患者拔管后躁动评分、警觉/镇静评分及术后6、12、24 h VAS评分均显著低于对照组，差异均有统计学意义（P＜0.05）。两组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：舒芬太尼联合瑞芬太尼应用于高龄患者腹部手术全身麻醉能有效稳定其血流动力学，降低应激反应，改善术后镇痛效果，且安全性较好。