瑞芬太尼联合丙泊酚靶控输注对子宫肌瘤患者腹腔镜手术中血流动力学及术后苏醒时间的影响

Effects of Target Controlled Infusion of Remifentanil Combined with Propofol on Hemodynamics and Postoperative Awakening Time in Laparoscopic Surgery on Patients with Uterine Fibroid

目的:探讨瑞芬太尼联合丙泊酚靶控输注对子宫肌瘤患者腹腔镜手术中血流动力学及术后苏醒时间的影响。方法:选取2015年11月—2017年10月登封市人民医院收治的拟行腹腔镜手术的子宫肌瘤患者82例作为研究对象,根据随机数字表法分为对照组与观察组,每组41例。观察组患者给予瑞芬太尼联合丙泊酚靶控输注,对照组患者给予七氟醚联合瑞芬太尼。观察两组患者手术时间、麻醉情况、疼痛程度及不良反应发生情况,于麻醉前(T_1)、麻醉10 min(T_2)、术后即刻(T_3)观察患者血流动力学指标变化情况。结果:两组患者手术时间的差异无统计学意义(P>0.05);观察组患者术后意识恢复时间、术后清醒时间明显短于对照组,视觉模拟评分明显低于对照组,差异均有统计学意义(P<0.05);T_1时,两组患者的心率、平均动脉压的差异无统计学意义(P>0.05);T_2、T_3时,两组患者的心率、平均动脉压明显高于T_1,但观察组患者明显低于对照组,差异均有统计学意义(P<0.05);观察组患者不良反应发生率为9.76%(4/41),明显低于对照组的26.83%(11/41),差异有统计学意义(P<0.05)。结论:瑞芬太尼联合丙泊酚靶控输注用于子宫肌瘤患者腹腔镜手术的麻醉效果较好,可缩短术后意识恢复及清醒时间,减轻术后疼痛,避免术中血流动力学大幅波动,且不良反应较少。

OBJECTIVE： To probe into the effects of target controlled infusion of remifentanil combined with propofol on hemodynamics and postoperative awakening time in laparoscopic surgery on patients with uterine fibroid. METHODS ： 82 patients with uterine fibroid undergoing laparoscopic surgery admitted into Dengfeng People＇ s Hospital from Nov. 2015 to Oct. 2017 were selected and divided into control group and observation group via random number table, with 41 cases in each. The observation group was given target controlled infusion of remifentanil combined with propofol, while the control group was given sevoflurane combined with remifentanil. Operation duration, anesthesia, degrees of pain and incidences of adverse drug reactions, changes of hemodynamics indices at before anesthesia （ T1 ）, 10 min after anesthesia （ T2 ） and immediately after operation （ T3 ） of two groups were observed. RESULTS ： There was no statistical significance in difference of operation duration between two groups （ P 〉 0. 05 ） ; the awareness restoration time and postoperative awakening time of observation group were significantly shorter than those of the control group, with significantly lower visual analogue scale scores, with statistically significant differences （P 〈 0. 05 ） ; at T1, there was no statistical significance in differences of heart rates and mean arterial pressures between two groups （P 〉 0.05 ） ; at T2 and T3, the heart rates and mean arterial pressures of both groups were significantly higher than those of T1, while those of observation group were significantly lower than the control group, with statistically significant differences （P 〈 0.05 ） ; the incidence of adverse drug reactions of observation group was 9.76% （4/41 ）, which was significantly lower than that of the control group （26.83% , 11/41 ）, with statistically significant difference （P 〈 0. 05 ）. CONCLUSIONS ： The anesthetic effect of target controlled infusion of remifentanil combined with propofol in laparoscopic surgery on patients with uterine fibroid is remarkable, which can significantly shorten awareness restoration time and awakening time, relieve postoperative pain and prevent sharp fluctuation of hemodynamics, with few adverse drug reactions.