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

A clinical study of sufentanil or remifentanil by target-controlled infusion on gynecologic laparoscopy surgery

目的:比较靶控输注(Target controlled infusion,TCI)舒芬太尼和瑞芬太尼用于妇科腹腔镜手术麻醉的临床效果。方法:92例美国麻醉医师协会(American society of anesthesiology,ASA)Ⅰ～Ⅱ级择期妇科腹腔镜手术患者,随机分为舒芬太尼组(S组)和瑞芬太尼组(R组),每组46例。舒芬太尼组麻醉诱导效应室TCI舒芬太尼0.5 ng/ml和血浆TCI丙泊酚3μg/ml,麻醉维持舒芬太尼0.3 ng/ml,丙泊酚3μg/ml输注;瑞芬太尼组麻醉诱导血浆TCI瑞芬太尼4 ng/ml和血浆TCI丙泊酚3μg/ml,麻醉维持瑞芬太尼3 ng/ml,丙泊酚3μg/ml输注。记录2组麻醉前(T0)、诱导后3 min(T1)、插管时(T2)、切皮(T3)、腹腔镜探查时(T4)、拔管(T5)时的收缩压、舒张压和心率的变化,比较术后患者的恢复情况,统计2组丙泊酚的用量。结果:2组T1时心率比T0均显著降低(P<0.05),瑞芬太尼组T1时的收缩压、舒张压低于舒芬太尼组(P<0.05);2组在T2、T3、T4时的收缩压、舒张压和心率差异无统计学意义(P>0.05);瑞芬太尼组T5时的收缩压、舒张压和心率高于舒芬太尼组(P<0.05);瑞芬太尼组停药至拔管的时间少于舒芬太尼组(P<0.05);2组丙泊酚的用量差异无统计学意义(P>0.05)。结论:TCI舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的围术期血流动力学平稳,但术毕TCI瑞芬太尼的患者应提前给予镇痛药。

Objective：To be compared to the clinical efficacy of sufentanil or remifentanil by target-controlled infusion（TCI） on gynecologic laparoscopy surgery.Methods：A total of 92 ASA I or II patients undergoing elective gynecologic laparoscopy operation were randomly divided into tow groups： sufentanil group（group S,n=46） and remifentanil group（group R,n=46）.Sufentanil of group S was administered by TCI at a target effect-site concertration of 0.5 ng/ml and propofol was 3 μg/ml during induction of anesthesia.Sufentanil of group S was administered by TCI at a target effec-site concertration of 0.3 ng/ml and propofol was 3 μg/ml during maintenance of anesthesia.Remifentanil of group R was administered by TCI at a target blood concertration of 4 ng/ml and propofol was 3 μg/ml during induction of anesthesia.Remifentanil of group R was administered by TCI at a target blood concertration of 4 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 preanesthesia（T0）,3 min after induction（T1）,intubation（T2）,incision（T3）,exploration with laparoscopy（T4） and extubation（T5） were recorded.The time from recovery profiles after operation were compared.Propofol of two groups were counted.Results：HR of two groups at T1 were lower those at T0（P0.05）,while at T1 SBP and DBP of group R were lower those of group S（P0.05）;SBP,DBP and HR of two groups were on different at T2,T3 and T4（P0.05）;SBP,DBP and HR of group R at T5 were higher those of group S（P0.05）;The time of group R from stoping infusion to extubation was lower that of group S（P0.05）,while recovery profiles of group S after operation were better than those of group R.Conclusion：Perioperation sufentanil or remifentanil by TCI on gynecologic laparoscopy operation are hemodynamics stability both,but the patients of remifentanil by TCI shoud give opioid drugs ahead the time termination operation.