舒芬太尼复合瑞芬太尼在食管癌手术中的镇痛效果及对应激反应的影响

Analgesic effect of Sufentanil combined with Remifentanil on esophageal cancer surgery and its effect on stress response

目的探讨舒芬太尼复合瑞芬太尼在食管癌手术的镇痛效果及对应激反应的影响。方法将2015年1月~2016年12月我院收治的90例行食管癌手术患者分成三组,30例采用舒芬太尼麻醉诱导(研究1组),30例给予瑞芬太尼麻醉诱导(研究2组),30例给予舒芬太尼复合瑞芬太尼麻醉诱导(研究3组),将三组患者不同时刻心率(HR)、舒张压(DBP)、收缩压(SBP)、去甲肾上腺素(NE)、肾上腺素(E)、血清皮质醇(Cor)以及术后VAS评分、拔管时间、要求镇痛治疗患者例数进行比较。结果 T_2时三组患者HR、SBP、DBP均较T1时下降,差异有统计学意义(P<0.05),其中研究2组T_3、T_5、T_7时HR、SBP、DBP较其他两组升高,差异有统计学意义(P<0.05)。研究2组血浆NE浓度在T_4、T_6、T_8时较其他两组升高,差异有统计学意义(P<0.05)。研究2组、研究3组术后拔管时间较研究1组要短,差异有统计学意义(P<0.05),研究2组VAS评分以及要求镇痛治疗患者的比率与其他两组差异有统计学意义(P<0.05)。结论在行食管癌手术患者麻醉选择舒芬太尼复合瑞芬太尼具有良好的镇痛效果,且应激反应小,患者血流动力学稳定性高,拔管时间短。

Objective To investigate the analgesic effect of Sufentanil combined with Remifentanil in esophageal cancer surgery and its effect on stress response.Methods 90 patients with esophageal cancer surgery from January 2015 to December 2016,were selected and divided into 3 groups,30 patients were given Sufentanil anesthesia induction （study group 1）,30 patients were given Remifentanil anesthesia induction （study group 2）,30 patients were given Sufentanil and Remifentanil anesthesia （study group 3）.HR,SBP,DBP,NE,E,Cor and VAS score,extubation time,eases of postoperative analgesic requirements in different time of the three groups were compared.Results HR,SBP and DBP of the three groups in T2 were significantly decreased compared with T1（P 〈 0.05）.HR,SBP and DBP in T3,T5 and T7 in study group 2 were significantly higher than those in the other two groups （P 〈0.05）.The plasma NE concentration in T4,T6 and T8 of study group 2 was significantly higher than that of the other two groups （P 〈 0.05）.The postoperative extubation time of study group 2 and 3 was significantly shorter than that of study group 1 （P〈 0.05）.There were significant differences in the VAS score and the ratio of patients who required analgesia between the study group 2 and the other two groups （P 〈 0.05）. Conclusion Selection of Sufentanil and Remifentanil has good analgesic effect of anesthesia in patients with esophageal cancer surgery,and stress response is little, hemodynamic stability is high,extubation time is short.