氢吗啡酮在妇科腹腔镜手术中的效果及对患者血流动力学和炎性因子的影响

摘要

目的:研究氢吗啡酮在妇科腹腔镜手术中的效果,并分析其对患者血流动力学、炎性因子及应激反应的影响.方法:选取我院择期行全麻下妇科腹腔镜手术的患者170例,并随机分为观察组(n=85)和对照组(n=85).在常规麻醉的基础上,观察组给予氢吗啡酮,对照组采用芬太尼.观察并比较2组患者不同时间点血流动力学变化;检测并比较两组血清炎性因子及应激反应指标水平变化.结果:与T1点比较,观察组T2点HR、SBP及MAP均显著降低(P<0.05),T3点恢复至T1水平(P>0.05),对照组T2至T3点HR、SBP及MAP均显著降低(P<0.01),且显著低于观察组(P<0.05或P<0.01);与麻醉前比较,麻醉后24 h两组IL-6、IL-10、TNF-α水平均明显上升(P<0.05或P<0.01),且观察组IL-10水平明显高于对照组,IL-6和TNF-α明显低于对照组(P<0.05或P<0.01);麻醉后24 h两组CRP、FC、A及NE水平均显著降低(P<0.05或P<0.01),且观察组显著低于对照组(P<0.05或P<0.01).结论:氢吗啡酮用于妇科腹腔镜手术不会对机体血流动力学造成较大影响,且机体应激反应小,炎症反应轻,更有助于患者术后恢复.%Objective: To study the effect of hydromorphone on gynecological laparoscopic operation and analyze its effect on the hemodynamics and inflammatory cytokines.Methods: A total of 170 patients who were underwent selective gynecological laparoscopic operation under general anesthesia were included in the study and randomized into the observation group (n=85) and the control group (n=85).On the basis of routine anesthesia, the patients in the observation group were given hydromorphone, while the patients in the control group were given fentanyl.The hemodynamic changes in different timing points in the two groups were observed and compared.The levels of serum inflammatory cytokines and stress reaction indicators in the two groups were detected and compared.Results: HR, SBP, and MAP at T2 in the observation group were significantly reduced when compared with at T1 (P<0.05 or P<0.01), those at T3 were recovered to levels at T1 (P>0.05).HR, SBP, and MAP at T2 and T3 in the control group were significantly reduced (P<0.01), and those were significantly lower than those in the observation group (P<0.05 or P<0.01).IL-6, IL-10, and TNF-α levels 24h after anesthesia in the two groups were significantly elevated when compared with before anesthesia (P<0.05 or P<0.01).IL-10 level in the observation group was significantly higher than that in the control group, while IL-6 and TNF-α were significantly lower than those in the control group (P<0.05 or P<0.01).CRP, FC, A, and NE levels 24h after anesthesia in the two groups were significantly reduced (P<0.05 or P<0.01), and those in the observation group were significantly lower than those in the control group (P<0.05 or P<0.01).Conclusions: Hydromorphone applied in the gynecological laparoscopic operation will not produce great effect on the hemodynamics, with small stress reaction and mild inflammatory reaction;therefore, it is more beneficial for the postoperative recovery.