舒芬太尼复合瑞芬太尼对胃癌根治术患者麻醉效果和应激反应的影响

Effects of sufentanil combined remifentanil on anesthesia and stress of patients with radical gastrectomy

目的探讨舒芬太尼复合瑞芬太尼麻醉对胃癌根治术患者麻醉效果、应激反应的影响。方法将2010年6月—2014年5月绍兴市人民医院择期行手术治疗的84例胃癌根治术患者随机分为2组,每组42例。对照组给予瑞芬太尼麻醉,观察组给予舒芬太尼复合瑞芬太尼麻醉。比较2组麻醉前(T1)、插管前(T2)、插管后1 min(T3)、拔管后1 min(T4)、拔管后5 min(T5)时血流动力学变化,拔管后10 min的警觉/镇静评分(OAA/S)和躁动评分(RS)以及术后6 h(T6)、12 h(T7)、24 h(T8)时的VAS评分;比较T1、T3、T4、T6、T7、T8时去甲肾上腺素(NE)、肾上腺素(E)水平。结果与T1点比较,2组T2点HR水平显著降低(P<0.05),2组T3~T4点HR水平显著升高(P<0.05),且观察组T3~T5点HR水平显著低于对照组(P<0.05)。与T1点比较,2组T2点MAP水平显著降低(P<0.05),对照组T3~T5点MAP水平显著升高(P<0.05),观察组T3~T5点MAP水平显著低于对照组(P<0.05)。观察组OAA/S、RS、VAS评分均明显低于对照组(P<0.05)。与T1点比较,2组T3、T4时2组血NE、E水平明显提高(P<0.05),T7、T8时2组血NE、E水平明显降低(P<0.05),观察组T3、T4、T6、T7、T8时血NE、E水平明显低于对照组(P<0.05)。结论相比于单用瑞芬太尼,舒芬太尼复合瑞芬太尼可有效维持胃癌根治术患者血流动力学,降低患者疼痛和应激反应。

Objective To investigate the effects of sufentanil combined remifentanil on anesthesia and stress of patients with radical gastrectomy. Methods Eighty-four patients with radical gastrectomy of Shaoxing people＇ s hospital from June,2010 to May, 2014 were randomly divided into two groups, each group 42 cases. The control group was given remifentanil anesthesia, and the observation group was given snfentanil combined remifentanil anesthesia. The hemodynamics at before anesthesia （ T1 ） , before intubation （ T2 ） , 1 min after intubation （ T3 ）, 1 min after extubation （ T4 ） , 5 rain after extubation（T5） ,Observer＇s assessment of alertness/sedation（OAA/S） scale and restless score（RS） at 10 min after extubation,VAS score at postoperative 6 h （ T6）, postoperative 12 h （ T7 ） and postoperative 24 h （ T8 ）, norepinephrine （ NE）, adrenaline （E） levels at T1 ,T3, T4,T6,T7,T8 of two groups were compared. Results Compared with T1, the HR levels at 3＂2 of two groups were significantly decreased （ P 〈 0.05 ） , HR levels at T3 - T4 of two groups were significantly increased（ P 〈 0.05 ） , and HR levels at T3 - T5 of observation group were significantly lower than those of control group （P 〈 0.05 ）. Compared with T1, the MAP levels at T2 of two groups were significantly decreased（ P 〈 0.05 ）, MAP levels at T3 - T5 of control group were significantly increased （ P 〈 0.05 ） , and MAP levels at T3 - T5 of observation group were significantly lower than that of control group（ P 〈 0.05 ）. The OAA/S, RS, VAS scores of observation group were significantly lower than those of control group（P 〈 0.05 ）. Compared with T1, the NE, E levels at T3 - T4 of two groups were significantly increased （ P 〈 0.05 ）, NE, E levels at T7 - T8 of two groups were significantly reduced （ P 〈 0.05 ）, and NE, E levels at T3, T4, T6, T7, T8 of observation group were significantly lower than those of control group （ P 〈 0.05 ）. Conclusion Compared to remifentanil alone, sufentanil combined remifentanil could effectively maintain hemodynamics, reduce pain and stress of patients with radical gastrectomy.