妇科腹腔镜手术应用瑞芬太尼和舒芬太尼苏醒质量的比较

The comparison between the quality of recovery from general anesthesia with remifentanil and sufentanil on gynaecologic loparoscopy operation

①目的比较瑞芬太尼和舒芬太尼应用于妇科腹腔镜手术患者术后苏醒质量的差异。②方法妇科腹腔镜手术患者70例，分为瑞芬太尼组（R组）和舒芬太尼组（S组），各35例。全麻诱导：R组和S组分别推注瑞芬太尼1．5μg／kg和舒芬太尼0．4μg／kg，同时推注咪达唑仑0．05mg／kg、苯磺顺阿曲库铵0．15mg／kg、丙泊酚2mg／kg。术中R组和S组分别以瑞芬太尼0．2μg／（kg·min）和舒芬太尼0．5μg／（kg·h）经推注泵注射，所有患者术中复合吸入1．5％～2．0％七氟醚维持麻醉，关气腹时停止所有麻醉药物。记录患者麻醉停药后自主呼吸恢复时间、睁眼时间、指令反应恢复时间、拔除气管导管时间；统计患者围拔管期并发症及不良反应发生情况；评定患者拔管后30分钟的Ramsay清醒评分；对患者拔管后5分钟、30分钟、1小时和3小时进行疼痛评分（VAS）。③结果S组患者各项苏醒指标比R组略长，但差异无统计学意义（P〉0．05）；R组患者术后躁动的发生率高于S组（P〈0．05）。与R组相比，S组Ramsay评级为1的患者明显偏少（P〈0．05）；S组患者在拔管后5分钟、30分钟、1小时的VAs评分均比R组低，差异有统计学意义（P〈0．05）；两组患者围拔管期各种不良反应发生率均较低，舒芬太尼组有1例发生呼吸抑制。④结论舒芬太尼和瑞芬太尼均可使患者快速安全苏醒，术后不良反应发生率均较低。舒芬太尼在降低拔管后切口疼痛、躁动的发生率方面优于瑞芬太尼，但需注意术后呼吸抑制。

Objective To compare the quality of recovery from anesthesia with remifentanil and sufentanil on gynaeeologie loparoseopy operation.Methods Seventy patients undergoing gynaeeologic loparoscopy operation were selected and divided into two groups randomly： group R （remifentanil） and group S （sufentanil）,each group had thirty five patients. Anesthesia of the two groups were induced with remifentanil 1.5μg/kg and sufentanil 0.4μg/kg,and at the same time midazolam 0.05mg/kg,eisa- tracurium besylate 0.15mg/kg,propofol 2mg/kg.All the patients inhaled sevoflurane of 1.5%-2.0% at the same time,patients in two groups were infused with remifentanil 0.2μg/（kg ·min）or sufentanil 0.5μg/（kg · h）,and they were stoped infusion at the time of stoping pneumoperitoneum. The follow- ing were recorded and compared：The duration from termination of surgery to full recovery of sponta- neously breathing, eye opening, response to instruction and endotracheal tube extubation; Postoperative complications.Ramsay score 30 minutes after extubation; VAS score at the time points：5 minutes after extubation,30 minutes after extubation, 1 hour after extubation and 3 hours after extubation.Results There were no statistically difference of the duration from termination of surgery to full re- covery of spontaneously breathing,eye opening,response to instructionand tracheal extubation In both groups;The patients of firstgrade of Ramsay score were fewer in group S than in group R;VAS score- sat 5 minutes after extubation,30min utes after extubation and 1 hour after extubation in group S were significantly lower than those in group R;The side effect during the recovery period of general anesthe- sia in both groups were low.Conclusion All patients in both groups can recovery from general anes- thesia quickly and safely, the side effect during the recovery period of general anesthesia in both groups are low.Sufentanil can reduce the incidence of postoperative pain and restlessness.But the respiratory depression need to pay attention.