妇科腹腔镜手术采用舒芬太尼和瑞芬太尼靶控输注静脉麻醉的临床效果研究

Research on Clinical Effect of Target Controlled Infusion Intravenous Anesthesia of Sufentanil and Remifentanil in the Gynecological Laparoscopic Surgery

目的在妇科腹腔镜手术中采用舒芬太尼和瑞芬太尼靶控输注静脉麻醉,并比较不同麻醉方式的临床效果。方法方便选取2015年3月—2016年3月来该院全麻下行妇科腹腔镜手术患者共100例,随机分组为A、B组,每组50例。A组麻醉靶控输注舒芬太尼,B组麻醉靶控输注瑞芬太尼,且麻醉中联合使用丙泊酚。记录两组患者于麻醉前(t1)、诱导后(t2)、插管时(t3)、切皮时(t4)、腹腔镜探查(t5)、拔管时(t6)的收缩压(SBP)、舒张压(DBP)、心率(HR)等血流动力学参数,比较在术后的恢复情况及丙泊酚用量。结果两组患者于t2时的HR(59.1±9.1)、(58.2±8.2)次/min均较t1(75.2±10.9)、(76.4±8.9)次/min降低,差异有统计学意义(P<0.05),两组患者在t3,t4,t5时的HR[t3(70.9±7.2)、(69.8±5.7)次/min,t4(74.2±5.6)、(72.3±6.3)次/min,t5(77.3±8.6)、(70.9±7.9)次/min]、SBP[t3(115.2±10.2)、(110.3±9.6)mm Hg,t4(111.2±8.4)、(110.9±3.9)mm Hg,t5(110.9±3.9)、(119.2±9.2)mm Hg]、DBP[t3(70.2±3.2)、(72.3±6.4)mm Hg,t4(70.9±9.6)、(77.2±8.4)mm Hg,t5(75.9±6.3)、(68.4±7.4)mm Hg],差异无统计学意义(P>0.05)。B组的拔管时间(5.2±2.2)min要低于A组(14.5±2.1)min,差异有统计学意义(P<0.05),两组患者使用丙泊酚用量差异无统计学意义(P>0.05)。结论在妇科腹腔镜手术中使用舒芬太尼和瑞芬太尼靶控输注静脉麻醉中血流动力学均平稳,在术后应提前给予瑞芬太尼镇痛药。

Objective To compare the clinical effect of target controlled infusion intravenous anesthesia of sufentanil and remifentanil in the gynecological laparoscopic surgery. Methods Convenient selection 100 cases of patients with gynecological laparoscopic surgery under the general anesthesia in our hospital from March 2015 to March 2016 were selected and randomly divided into two groups with 50 cases in each, the group A adopted the target controlled infusion intravenous anesthesia of sufentanil and propofol, the group B adopted the target controlled infusion intravenous anesthesia of remifentanil and propofol, and the SBP, DBP and HR before anesthesia（t1）, after induction（t2）, at intubatton（t3）, at skin incision（t4）, at laparoscopic exploratory operation（t5）and at extubation（t6） of the two groups were recorded. Results The HR at t2 of patients decreased compared with that at t1, [（59.1±9.1）,（58.2±8.2）times/min vs（75.2±10.9）,（76.4±8.9）times/min], and the difference was statistically significant（P〈0.05）, and the differences in the HR, SBP, DBP at t3,t4,t5 between the two groups were not statistically significant[t3（70.9±7.2）、（69.8±5.7）times/min,t4（74.2±5.6）、（72.3±6.3）times/min,t5（77.3±8.6）、（70.9±7.9）times/min]、SBP[t3（115.2±10.2）、（110.3±9.6）mmHg,t4（111.2±8.4）、（110.9±3.9）mmHg,t5（119.2±9.2）、（111.9±10.2）mmHg]、DBP[t3（70.2±3.2）、（72.3±6.4）mmHg,t4（70.9±9.6）、（77.2±8.4）mmHg,t5（75.9±6.3）、（68.4±7.4）mmHg], and the time to extubation in the group B was lower than that in the group A, [（5.2±2.2）min vs（14.5±2.1）min], and the difference was statistically significant（P〈0.05）, and the difference in the usage of propofol between the two groups was not statistically significant（P〉0.05）.Conclusion The hemodynamics of target controlled infusion intravenous anesthesia of sufentanil and remifentanil in the gynecological laparoscopic surgery is steady, and we should give the patients remifentanil analgesic agents in advance after operation.