丙泊酚联合阿芬太尼诱导喉罩在宫腔镜电切术患者镇静效果及对血清NES、S100β蛋白的影响

Effect of Propofol combined with anesthesia on sedative effect of laryngeal mask airway in patients undergoing hysteroscopic electrotom and levels of NES and S100β

目的探讨丙泊酚联合阿芬太尼诱导喉罩在宫腔镜电切术患者的镇静效果及对血清神经元特异性烯醇化酶(NSE)、S100钙结合蛋白β(S100β蛋白)水平的影响。方法选取2020年6月-2022年5月在淮北市妇幼保健院行宫腔镜电切术的患者146例,根据随机数字表法分为两组,各73例,对照组给予丙泊酚联合舒芬太尼,试验组给予丙泊酚联合阿芬太尼。比较两组患者的麻醉效果、全麻术后恶心、呕吐(PONV)情况,并比较术后不同时间点的平均动脉压(MAP)、心率(HR)、血清NSE、S100β蛋白水平。结果两组达到镇静所需时间、丙泊酚用量比较差异无统计学意义(P>0.05),但试验组患者苏醒时间短于对照组[(4.36±1.25)vs.(7.38±2.22)min,(t=10.128,P<0.01)];试验组PONV发生率为10.96%,明显低于对照组的28.77%(χ^(2)=7.272,P=0.007),但两组术后疼痛比较差异无统计学意义(P>0.05);与本组T0比较,T1~T4时两组MAP、HR均降低(P均<0.05);T4时点试验组MAP高于对照组[(76.39±13.28)vs.(72.63±11.78)mmhg,(t=-1.810,P=0.036)];与诱导前相比,术后1 d~术后2 d时两组血清NES、S100β蛋白水平均降低(P均<0.05);术后1 d~术后2 d,试验组血清NES、S100β蛋白水平均低于对照组[NES:(15.38±2.69)vs.(21.18±2.74),(18.03±2.86)vs.(23.35±3.27),(17.28±2.09)vs.(21.29±2.82),(t=12.906~9.761,均P<0.01);S100β:(180.51±44.15)vs.(216.26±42.31),(224.69±49.32)vs.(268.53±50.89),(202.35±52.85)vs.(249.68±55.15),(t=4.995~5.294,均P<0.01)]。试验组不良反应发生率为15.07%,明显低于对照组的32.88%(χ^(2)=6.351,P=0.012)。结论丙泊酚联合阿芬太尼诱导喉置能有效控制宫腔镜电切术患者的心率、血压波动,术后患者苏醒迅速,降低恶心呕吐发生,且对脑神经影响小,具有较高的医学实用价值。

Objective To investigate the sedative effect of propofol combined with alfentanil induced laryngeal mask airway on patients undergoing hysteroscopic electrotomy and its effect on serum neuron specific enolase(NSE)and S100 calcium binding proteinβ(S100βProtein)level.Methods From June 2020to May 2022,146patients who underwent hysteroscopic electrotomy in our hospital were selected and divided into two groups according to the random number table,73 patients in each group.The control group was given propofol combined with sufentanil,and the test group was given propofol combined with alfentanil.The anesthesia effect,nausea and vomiting(PONV)after general anesthesia were compared between the two groups,and the mean arterial pressure(MAP),heart rate(HR),serum NSE,S100 at different time points after surgery were compared β Protein level.Results There was no significant difference in the time needed to achieve sedation and the amount of propofol between the two groups(P>0.05),but the recovery time of patients in the test group was shorter than that in the control group[(4.36±1.25)vs(7.38±2.22)min,(t=10.128,P<0.01)];The incidence of PONV in the test group was 10.96%,significantly lower than 28.77%in the control group(χ^(2)=7.272,P=0.007),but there was no statistically significant difference in postoperative pain between the two groups(P>0.05);Compared with T0in this group,MAP and HR in both groups decreased from T1 to T4(P<0.05);MAP in the test group at T4 time point was higher than that in the control group[(76.39±13.28)vs.(72.63±11.78)mmHg,(t=-1.810,P=0.036)];Compared with that before induction,the serum NES and S100of the two groups from 1day to 2 days after operation β The protein level decreased(P<0.05);From 1 day to 2 days after operation,serum NES and S100 in the test group β Protein levels were lower than those in the control group[NES:(15.38±2.69)vs.(21.18±2.74),(18.03±2.86)vs.(23.35±3.27),(17.28±2.09)vs.(21.29±2.82),(t=12.906~9.761,all P<0.01);S100β:(180.51±44.15)vs.(216.26±42.31),(224.69±49.32)vs.(268.53±50.89),(202.35±52.85)vs.(249.68±55.15),(t=4.995~5.294,all P<0.01)].The incidence of adverse reactions in the test group was 15.07%,significantly lower than 32.88% in the control group(χ^(2)=6.351,P=0.012).Conclusion Propofol combined with alfentanil induced laryngeal intubation can effectively control the fluctuation of heart rate and blood pressure in patients undergoing hysteroscopic electrotomy.Patients wake up quickly after operation,reduce nausea and vomiting,and have little impact on the cerebral nerves.It has high medical practical value.