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

Clinical study of target-controlled infusion of sufentanil or remifentanil in gynecologic operation

目的探讨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效果。方法将2015年1月-2016年6月择期行妇科腹腔镜手术患者(70例)随机分为异丙酚复合瑞芬太尼组(PR组,n=35)和异丙酚复合舒芬太尼组(PS组,n=35),PR组设定瑞芬太尼血浆靶浓度为4ng/mL,实施异丙酚(3μg/mL)及瑞芬太尼复合靶控输注,PS组设定舒芬太尼靶控浓度为0.5ng/mL,实施异丙酚(3μg/mL)及舒芬太尼复合靶控输注。统计异丙酚的用量,比较2组麻醉前(T_0)、诱导后3min(T_1)、插管时(T_2)、切皮(T_3)、腹腔探查时(T_4)、拔管(T_5)时收缩压(SBP)、舒张压(DBP)和心率(HR)的差异,观察2组术后睁眼时间、拔管时间等指标。对2组术后视觉模拟评分(VAS)和警觉-镇静评分(OAAS)进行比较。结果 T_1时2组患者SBP、DBP及HR较T_0时降低,差异有统计学意义(P<0.05)。PR组T_1时SBP、DBP低于PS组,T_5时PR组SBP、DBP、HR高于PS组,差异均有统计学意义(P<0.05)。PS组呼吸恢复时间、苏醒睁眼时间、拔管时间、定向力恢复时间较PR组长,PS组术后60、90、120min VAS评分低于PR组,差异有均统计学意义(P<0.05)。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,舒芬太尼可以发挥更为显著的镇痛效能。

Objective To investigate the effect of target-controlled infusion （TCI） of sufentanil or remifen- tanil in gynecologic laparoscopic operation. Methods From January 2015-June 2016, 70 patients under- went the elective gynecologic laparoscopic operation were randomly divided into propofol combined with remifentanil group （PR group, n =35）, and propofol combined with sufentanil group （PS group, n =35）. PR group was administrated by TCI with remifentanil at a target blood concentration of 4 ng/mL and propofol was 3 μg/mL during maintenance of anesthesia. PS group was administrated by TCI with sufen- tanil at a target blood concentration of 0.5 ng/mL and propofol was 3 μg/mL during maintenance of anes- thesia. Systolic blood pressure （SBP）, diastolic blood pressure （DBP） and heart rate（HR） at the time of preauesthesia （T0）, 3 rain after induction （T1）, intubation （T2）, incision （T3）, exploration with laparosco- py （T4） and extubation （T5） were recorded. VAS and OAAS scores in two group postoperative were com- pared. Results SBP, DBP and HR were lower at T1 compared with To, the difference was statistically sig- nificant （P 〈0.05） ; SBP, DBP in PR group were lower than the PR group at T2 , the difference was staffs tically significant （P 〈0.05）. SBP, DBP, HR in PR group was higher than the PS group at T1, the differ- ence was statistically significant （P 〈 0.05）. Time from stopping administration of anesthetic until recovery breath, eye opening time, extubation recovery time of PS group was significantly longer than that of PR group. In both groups, there was no significant difference of OAAS scores at any point time, VAS in PS group was lower than that of PR group at the time of 60, 90, 120 min, the difference was statistical- ly significant （P 〈0.05）. Conclusion The sufentanil and propofol combined anesthesia in gynecological laparoscopic surgery was shown to be able to stabilize the hemodynamics,improving the quality of postop- erative recovery. Thereforesufentanil can play a more significant analgesic efficacy.