瑞芬太尼全麻在经皮肾镜碎石手术麻醉中的应用

Application of Remifentanil General Anesthesia in Percutaneous Nephrolithotomy

目的:探讨瑞芬太尼全麻在经皮肾镜碎石手术麻醉中的效果与价值。方法:选择本院在2016年2月—2018年2月期间收治的经皮肾镜碎石术治疗的住院患者50例,采用随机数字表法将其分为观察组与对照组各25例,我院为两组患者均提供常规麻醉准备,对照组患者采用舒芬太尼结合丙泊酚维持麻醉,为观察组患者提供术中瑞芬太尼结合丙泊酚维持麻醉,比较两组患者的麻醉效果、手术时间、清醒时间、麻醉药物用量、出血量等指标,同时记录并比较两组患者麻醉前T0、麻醉诱导2minT1、气管插管后2minT2、手术后2minT3、手术后20minT4以及拔管前T5等不同时段的收缩压与舒张压,比较患者麻醉过程中出现的不良反应。结果:观察组患者麻醉优的有17例,良有8例,优良率达到100%;对照组患者麻醉效果优、良、差分别为6例、11例和8例,麻醉优良率仅为68%,明显低于观察组患者,P<0.05。观察组患者的手术时间、术后清醒时间、麻醉药用量以及术中出血量分别为(136.3±27.2)min、(7.5±3.2)min、(932.3±278.2)mg和(108.3±13.5)mL,对照组患者的对应数据分别是(145.4±39.3)min、(8.7±3.1)min、(842.5±287.4)mg、(112.4±15.8)mL,各项指标显示观察组患者比对照组更好,P<0.05。在不同时段的收缩压与舒张压指标上,观察组患者除了T1时段有明显下降的趋势,其他阶段的指标波动较小,而对照组患者的收缩压与舒张压变化幅度明显偏大,P<0.05。两组患者麻醉过程中均未出现不良反应。结论:瑞芬太尼全麻应用在经皮肾镜碎石手术的麻醉临床上,麻醉效果显著,对患者舒张压与收缩压的影响较小,缩短了手术时间和患者意识恢复时间,安全可靠,具有很高的应用价值。

Objective： To investigate the effect and value of remifentanil general anesthesia in percutaneous nephrolithotripsy. Methods： Fifty patients treated with percutaneous nephrolithotripsy from February 2016 to February 2018 in our hospital were selected and randomly divided into two groups： the observation group （n=25） and the control group （n=25）. The patients in the control group were treated with sufentanil combined with propofol to maintain anesthesia, and the patients in the observation group were given intraoperative remifentanil combined with propofol maintenance anesthesia. Operation time, waking time, anesthetic dosage, bleeding volume, etc were compared. At the same time, the systolic and diastolic blood pressure （SBP） and diastolic pressure （DBP） were recorded and compared between the two groups before anesthesia, 2 min T 1, 2 min T 2 after tracheal intubation, 2 min T 3 after operation, 20 min T4 and T 5 before extubation. Results： In the observation group, 17 cases were excellent anesthesia, 8 cases were good, the excellent and good rate was 100%, while in the control group, the anesthetic effect was excellent, good and poor were 6 cases, 11 cases and 8 cases, respectively. The excellent and good rate of anesthesia was only 68%, which was significantly lower than that of the observation group （P〈0.05）. The operative time of the patients in the observation group, the postoperative waking time, the dosage of anesthetic and the amount of intraoperative bleeding were 136.3±27.2min, 7.5±3.2min, 932.3±278.2） mg and 108.3±13.5 mL, respectively. The corresponding data of the control group were 145.4±39.3min, 8.7±3.1min, 842.5±287.4mg / min, 112.4±15.8mL/mL, respectively. The indexes showed that the patients in the observation group were better than those in the control group （P〈0.05）. Systolic and diastolic blood pressure indexes in different periods of time were observed in the observation group. In addition to T1 period, the index fiuctuated slightly in other stages, the range of systolic and diastolic blood pressure in control group was significantly larger than that in control group （P〈0.05）. There were no adverse reactions during anesthesia in both groups. Conclusion： General remifentanil anesthesia is effective in the treatment of percutaneous nephrolithotripsy, and has little effect on diastolic blood pressure and systolic blood pressure, shortens operation time and consciousness recovery time, and is safe and reliable. It has high application value.