靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床研究

摘要

Objective To investigate the effect of target-controlled infusion (TCI) of sufentanil or remifentanil in gynecologic laparoscopic operation.Methods From January 2015-June 2016, 70 patients underwent the elective gynecologic laparoscopic operation were randomly divided into propofol combined with remifentanil group (PR group, n =35), and propofol combined with sufentanil group (PS group, n =35).PR group was administrated by TCI with remifentanil at a target blood concentration of 4 ng/mL and propofol was 3 μg/mL during maintenance of anesthesia.PS group was administrated by TCI with sufentanil at a target blood concentration of 0.5 ng/mL and propofol was 3 μg/mL during maintenance of anesthesia.Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate(HR) at the time of preauesthesia (T-0), 3 min after induction (T-1),intubation (T-2),incision (T-3),exploration with laparoscopy (T-4) and extubation (T-5) were recorded.VAS and OAAS scores in two group postoperative were compared.Results SBP, DBP and HR were lower at T-1 compared with T-0, the difference was statistically significant (P <0.05);SBP, DBP in PR group were lower than the PR group at T-1, the difference was statistically significant (P <0.05).SBP, DBP, HR in PR group was higher than the PS group at T-5, the difference was statistically significant (P <0.05).Time from stopping administration of anesthetic until recovery breath, eye opening time, extubation recovery time of PS group was significantly longer than that of PR group.In both groups, there was no significant difference of OAAS scores at any point time, VAS in PS group was lower than that of PR group at the time of 60, 90, 120 min, the difference was statistically significant (P <0.05).Conclusion The sufentanil and propofol combined anesthesia in gynecological laparoscopic surgery was shown to be able to stabilize the hemodynamics,improving the quality of postoperative recovery.Thereforesufentanil can play a more significant analgesic efficacy.%目的 探讨靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床效果.方法 将2015年1月-2016年6月择期行妇科腹腔镜手术患者(70例)随机分为异丙酚复合瑞芬太尼组(PR组, n =35)和异丙酚复合舒芬太尼组(PS组, n =35),PR组设定瑞芬太尼血浆靶浓度为4 ng/mL,实施异丙酚(3 μg/mL)及瑞芬太尼复合靶控输注,PS组设定舒芬太尼靶控浓度为0.5 ng/mL,实施异丙酚(3 μg/mL)及舒芬太尼复合靶控输注.统计异丙酚的用量,比较2组麻醉前(T-0)、诱导后3 min(T-1)、插管时(T-2)、切皮(T-3)、腹腔探查时(T-4)、拔管(T-5)时收缩压(SBP)、舒张压(DBP)和心率(HR)的差异,观察2组术后睁眼时间、拔管时间等指标.对2组术后视觉模拟评分(VAS)和警觉-镇静评分(OAAS)进行比较.结果 T-1时2组患者SBP、DBP及HR较T-0时降低,差异有统计学意义 (P <0.05).PR组T-1时SBP、DBP低于PS组,T-5时PR组SBP、DBP、HR高于PS组,差异均有统计学意义 (P <0.05).PS组呼吸恢复时间、苏醒睁眼时间、拔管时间、定向力恢复时间较PR组长,PS组术后60、90、120 min VAS评分低于PR组,差异有均统计学意义 (P <0.05).结论 舒芬太尼异丙酚靶控输注围术期血流动力学更加平稳,舒芬太尼可以发挥更为显著的镇痛效能.