舒芬太尼与瑞芬太尼联合麻醉在腹腔镜子宫切除手术中的应用

Application of sufentanil combined with remifentanil in laparoscopic hysterectomy

目的探讨舒芬太尼与瑞芬太尼联合麻醉对腹腔镜子宫切除手术患者血清一氧化氮(NO)/内皮素-1(ET-1)平衡及血流动力学影响。方法将72例择期腹腔镜子宫切除手术患者随机分为联合组和对照组,分别采用舒芬太尼联合瑞芬太尼麻醉及单独瑞芬太尼麻醉。记录两组麻醉诱导前(T_1)、诱导后(T_2)、插管时(T_3)及拔管时(T_4)血清NO及ET-1水平、血流动力学变化及不良反应。结果对照组T_2、T_3、T_4时HR和MAP与T_1时比较均上升(P<0.05),联合组T_2、T_3、T_4时HR和MAP与T_1时比较变化不明显(P>0.05),且对照组T_2、T_3、T_4时HR和MAP高于同时点联合组(P<0.05)。两组T_2、T_3、T_4时NO及ET-1水平与T_1时比较均上升(P<0.05),联合组NO水平上升幅度小于对照组,ET-1水平上升幅度大于对照组(P<0.05)。两组治疗中共发生药物不良反应6例,联合组4例,对照组2例,两组差异不明显(χ2=0.18,P>0.05)。结论舒芬太尼与瑞芬太尼联合麻醉用于腹腔镜子宫切除术对血流动力学影响小,安全性较好,作用可能与其可更好维持血清NO/ET-1平衡、改善内皮细胞功能密切相关。

Objective To investigate the effect of sufentanil combined with remifentanil on serum nitric oxide （NO）/en dothelin-1 （ET-1） balance and hemodynamics in patients undergoing laparoscopic hysterectomy. Methods 72 cases of elective laparoscopic hysterectomy were randomly divided into combined group treated with sufentanil combined with remifentanil anesthesia and control group treated with remifentanil alone. The levels of serum NO and ET-1, hemodynamics and adverse reactions in the two groups were recorded before induction（Tj）, after induction（T2）, when intubation （T3） and when extubation（T4）. Results The HR and MAP at T2, T3 and T4 were increased compared with those at Tm in the control group（P〈0.05）. And the changes of HR and MAP were not significant at T2, T3 and T4 compared with those at TI in the combined group（P〉0.05）. The HR and MAP in the control group were higher than those of the combined group at T2, T3 and T4 （P〈0.05）. The levels of NO and ET-1 in the two groups at T2, T3 and T4 were increased compared with those at TI（P〈0.05）. The increase rate of NO level in the combined group was lower than that in the control group （P〈0.05）. The increase rate of ET-1 in the combined group was higher than that in the control group（P〈0.05）. There were 6 cases of adverse reactions in the treatment of the two groups, including 4 cases in combined group and 2 cases in control group. There was no significant difference between the two groups（X2=0.18, P〉0.05）. Conclusion The sufen tanil and remifentanil combined anesthesia for laparoscopic hysterectomy has less effect on hemodynamics and better safety, which may be closely related to the better maintaining of serum NO/ET-1 balance and improvement of endothelial function.