老年患者腹腔镜下直肠癌手术时异丙酚复合舒芬太尼或瑞芬太尼的对比观察

Comparison of the effects of propofol combined with sufentanil or remifentanil anesthesia during laparoscopic surgery for colorectal carcinoma in elderly patients

目的观察舒芬太尼、瑞芬太尼用于老年患者腹腔镜直肠癌手术对血液动力学和术后早期认知功能的影响。方法美国麻醉医师协会分级Ⅰ～Ⅱ级择期行腹腔镜直肠癌根治术老年患者60例,随机分为舒芬太尼组和瑞芬太尼组,每组30例;复合靶控输注异丙酚并记录诱导前5 min(T0)、气腹前1 min(T1)、气腹后5 min(T2)、气腹后10 min(T3)、气腹后20 min(T4)、拔管后5 min(T5)的平均动脉压(MAP)、心率(HR)、呼气末二氧化碳分压(PetCO2)、脑电双频指数(BIS)、自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间、术后伤口疼痛程度及早期认知功能情况。结果瑞芬太尼组在T5时MAP、HR较T0升高(P<0.05),而舒芬太尼组在该时点无明显变化(P>0.05);2组患者的MAP、HR在T2、T3时较T1升高(P<0.05),BIS值在T2、T3、T4时较T1均升高(P<0.05);与瑞芬太尼组比较,T5时舒芬太尼组MAP、HR明显降低(P<0.05),其他时点2组比较差异无统计学意义(P>0.05);2组各时点BIS值、PetCO2比较差异无统计学意义(P>0.05);与瑞芬太尼组相比,舒芬太尼组自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间均较长(P<0.05,P<0.01);舒芬太尼组拔管时警觉/镇静(OAA/S)评分低于瑞芬太尼组(P<0.05);术后1 h瑞芬太尼组疼痛程度口头分级(VAS)评分高于舒芬太尼组(P<0.05),而术后24 h 2组VAS评分比较差异无统计学意义(P>0.05);与术前比较,2组术后30 min及1、3、6、24 h的简易精神量表评分均降低(P<0.05);舒芬太尼组术后30 min及1、3 h评分低于瑞芬太尼组(P<0.05)。结论靶控输注异丙酚复合舒芬太尼更适用于老年患者尤其是可能存在较大血流动力学波动的患者。

Objective To investigate the effects of sufentanyl and remifentanil on haemodynamics and postoperative recognition in elderly patients with rectal cancer during laparoscopic surgery.Methods Sixty patients（ASAⅠ~Ⅱ） scheduled for laparoscopic surgery of rectal carcinoma were randomly divided into sufentanyl group and remifentanil group,thirty cases in each group.The composite target-controlled infusion of propofol was used in the two groups.In two groups,the following indices were recorded and compared,including mean arterial pressure（MAP）,heart rate（HR）,pressure of end-tidal CO2（PetCO2）,bispectral index（BIS） at the moment of five minutes before induction（T0）,one minute before pneumoperitoneum（T1）,and five minutes（T2）,ten minutes（T3）,twenty minutes（T4） after CO2 pneumoperitoneum,and five minutes after extubation（T5）;spontaneous breathing recovery time,wake-up time,extubation time,orientation recovery time,the degree of wound pain after surgery,and postoperative recognition.Results MAP and HR of the remifentanil group on T5 were higher than those on T0（P0.05）.In two groups,MAP and HR on T2 and T3 were higher than those on T1（P0.05）.There was no significant difference in BIS and PetCO2 between two groups（P〉0.05）.Compared with remifentanil group,spontaneous breathing recovery time,wake-up time,extubation time,and orientation recovery time were longer（P0.05）.The minimental state examination（MMSE） scores of two groups on postoperation thirty minutes,one hour,three hours,six hours and twenty-four hours were lower than those before treatment（P〈0.05）.The MMSE scores of the sufentanyl group on postoperation thirty minutes,one hour,and three hours were lower than those of the remifentanil group（P〈0.05）.Conclusion Target-controlled infusion of propofol combined with sufentanil is more suitable for elderly patients with large hemodynamic fluctuations particularly.