舒芬太尼和瑞芬太尼靶控输注静脉麻醉用于妇科腹腔镜手术

Comparison target-controlled infusion sufentanil or remifentanil on gynaecologic laparoscopy operation

目的比较靶控舒芬太尼和瑞芬太尼在妇科腹腔镜手术麻醉的临床效果,为临床麻醉的药物选择提供依据。方法30例择期全麻下行妇科腹腔镜的病人,ASA为1、2级,随机分为两组:异丙酚复合靶浓度0.5ng/mL舒芬太尼组(SF组,n=15);异丙酚复合靶浓度4.0ng/mL瑞芬太尼组(RF组,n=15)。两组患者均采用效应室靶控输注,异丙酚靶浓度为3μg/mL。观察麻醉诱导、手术开始以及围拔管期的血流动力学改变;停药后患者的呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间、停留ICU时间、第一次主诉需要镇痛药的时间;VAS评分;OAAS评分;术后恶心、呕吐并发症发生率和术中知晓情况。结果⑴RF组麻醉诱导时的SBP、DBP、MBP低于SF组(P<0.05);两组在麻醉诱导时心率比麻醉前均显著降低(P<0.05);两组在手术开始时的SBP、DBP、MBP无明显变化;RF组围拔管期的SBP、DBP、MBP均高于SF组(P<0.05);⑵SF组停药后的呼吸恢复、睁眼时间、拔管时间、定向力恢复时间高于RF组(P<0.05),RF组停止异丙酚后30min内的OAAS评分高于SF组(P<0.05),30min后的OAAS评分两组间差异无显著性(P>0.05);⑶RF组围拔管期的躁动发生率多于SF组(P<0.05)、RF组第1次主诉需要阿片类药物时间早于SF组(P<0.05)、需要镇痛药的比例高于SF组(P<0.05);⑷两组患者术后24h内恶心、呕吐发生率差异无显著性(P>0.05),两组患者术后随访均未发生术中知晓。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,但术毕30min内意识恢复慢于瑞芬太尼组;瑞芬太尼异丙酚靶控输注患者苏醒迅速,躁动发生率高,应提前给予镇痛药。

[Objective] To explore the effect of sufentanil compared with remifentanil during target-controlled infusion total intravenous anesthesia. [Methods] 30 ASA 1-2 patients undergoing elective gynaecologic loparoscopy were randomly divided into two groups： Group SF received TIVE using a propofol and sufentanil-based TCI system for induction and maintenance of anaesthesia （n =15）; Group RF received TIVA using a propofol and remifentanilbased TCI system for induction and maintenance of anaesthesia （n =15）; Sufentanil was set at 0.5 ng/mL, remffentanil was set at 4 ng/mL and propofol were both set at 3ug/ml. The hemodynamics during induction anaesthesia and recovery profiles and the complications after operation were compared. [Results] （1）Patients exhibited lower systolic blood pressure and diastolic blood pressure during induction of anaesthesia were significantly lower than those before anaeshesia （P 〈0.05）; Patients exhibited lower systolic blood pressure, medial blood pressure and diastolic blood pressure during indunction of anaesthesia in group RF than in group SF（P 〈0.05）. At the beginning of the operations both groups＇ hemodynamics was indifference （P 〉0.05）; The systolic blood pressure, medial blood pressure and diastolic blood pressure during tracheal extubation was higher in group RF than in group SF （P 〈0.05）. （2） Time from stopping administration of anaesthetics until recovery breath, eyes opening, tracheal extubation, recovery of orientation（time,space） were longer in group SF than in group RF （P 〈0.05）. The observer of assessment of alertness/sedation（OAAS） scores at 30 minutes after stopping infusing propofol was lower in group SF than in group RF （P 〈0.05）. 30 minutes later the OAAS score in two groups have no significant difference ; （3）The rate of restlessness and appealing to opioid drugs of group SF were lower than group RF （P 〈0.05）; （4）The rate of vomiting and other complication have no difference in two groups after 24 hours from operation, patients underwent consciousness during operation. [Conclusions] Compared with remifentanil/propofol TCI-based anaesthesia, sufentailnil/propofol TCI-based anaesthesia is associated with better hemodynamics stability, and less painful complications, but the recovery times in group SF after stopping infusing propofol are longer than in group RF. In order to reduce the rate of restlessness we shoud give patients opioid drugs ahead the time termination operation.