七氟醚复合瑞芬太尼对腹腔镜子宫肌瘤切除术患者应激反应、血流动力学及认知功能的影响

Influence of sevoflurane and remifentanil on stress response, hemodynamics and cognitive function in patients with laparoscopic hysteromyomectomy

目的探讨七氟醚复合瑞芬太尼对腹腔镜子宫肌瘤切除术患者应激反应、血流动力学及认知功能的影响。方法选取2016年4月至2017月4月在浙江医科大学附属第五医院行腹腔镜子宫肌瘤切除术的120例患者,采用随机数字表法分为观察组和对照组,每组60例。两组均择期行手术治疗,术中采用瑞芬太尼进行麻醉诱导,对照组应用丙泊酚维持麻醉,而观察组静吸七氟醚维持麻醉。分别于麻醉前5分钟(T_0)、气腹30分钟(T_1)、手术结束时(T_2)测定血清皮质醇(cortisol,COR)、肾上腺素(adrenaline,A)、去甲肾上腺素(noradrenaline,NA)、血糖(glucose,GLU)水平以评估患者的应激反应水平,并测定心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、血氧饱和度(surplus pulse O_2,SpO_2)等血流动力学指标,于术前1天及术后1天采用简易精神状态量表(mini-mental state examinatlon,MMSE)和连线试验(trail making test,TMT)评价患者认知功能,并记录两组患者头昏、恶心呕吐、嗜睡、躁动等不良反应发生情况。结果观察组T_0时COR、A、NA、GLU及HR、MAP、SpO_2与对照组比较差异均无显著性(P>0.05),而T_1、T_2时间点COR、A、NA、GLU、HR、MAP、SpO_2水平均明显低于对照组,差异有显著性(P<0.05)。术后1天时观察组的MMSE评分为(27.97±0.26)分,明显高于对照组的(25.28±0.62)分,TMT完成时间为(35.20±1.85)秒,明显短于对照组的(39.36±2.13)秒,差异均有显著性(P<0.05)。观察组术后并发症发生率为8.33%,明显低于对照组的21.67%,差异有显著性(P<0.05)。结论七氟醚复合瑞芬太尼麻醉效果显著,且能有效减轻患者的应激反应及对血流动力学、认知功能的影响,是一种安全、高效、理想的麻醉方法。

Objective To investigate the influence of sevoflurane and remifentanil on stress response, hemodynamics and cognitive function in patients with uterine fibroid. Method 120 patients with laparoscopic hysteromyomectomy in our hospital from April 2016 to April 2017 were selected, and they were divided into two groups by random number table, 60 cases in each group. Two groups were treated with elective operations, and they were given anesthesia induction with remifentanil. Control group was given propofol to maintain anesthesia, while observation group was given intravenous-inhalation of sevoflurane. The levels of stress response [cortisol（COR）, adrenaline（A）, noradrenaline（NA）, glucose（GLU）] and changes of hemodynamics [heart rate（HR）, mean arterial pressure（MAP）, surplus pulse O2（SpO2）] before anesthesia for 5 min（T0）, pneumoperitoneum 30 min（T1）, at the end of operation（T2） in patients were evaluated; The cognitive function [Mini-mental State Examination（MMSE）, Trail Making Test（TMT）] of patients in preoperative and postoperative 1 d were assessed. The adverse reactions（dizziness, nausea and vomiting, somnolence, agitation, etc.） of two groups were recorded. Result The COR, A, NA, GLU, HR, MAP, SpO2 in observation group and control group at T0 were compared, there was no statistical difference（P〉0.05）. The levels of COR, A, NA, GLU, HR, MAP, SpO2 in observation group at T1 and T2 were lower than those in control group（P〈0.05）. The postoperative 1 d MMSE score of observation group [（27.97±0.26）points] was higher than control group [（25.28±0.62）points], the TMT finish time of observation group [（35.20±1.85）s] was shorter than control group [（39.36±2.13）s], and the incidence of complications in observation group（8.33%） was lower than control group（21.67%）（P〈0.05）. Conclusion The anesthesia effect of sevoflurane combined with remifentanil is significant, it can alleviate the influence on stress response, hemodynamics and cognitive function, which is a safe, efficient and satisfactory anesthetic method.