瑞芬太尼与舒芬太尼于膀胱癌腹腔镜根治术麻醉效果比较

Comparison of anesthetic effects of remifentanil and sufentanil in laparoscopic radical cystectomy for bladder cancer

目的对比瑞芬太尼与舒芬太尼对膀胱癌腹腔镜根治术患者麻醉效果。方法将79例膀胱癌患者随机分为观察组(n=40)与对照组(n=39),均行膀胱癌腹腔镜根治术。均采用气管插管全麻,麻醉诱导后,对照组给予0.3μg/L舒芬太尼联合3 mg/L丙泊酚维持麻醉;观察组给予0.3μg/L瑞芬太尼联合3 mg/L丙泊酚维持麻醉。对比两组不同时间点收缩压(SBP)、舒张压(DBP)、心率(HR)变化,术后呼吸恢复时间、拔管时间和术后24 h镇痛药用量以及并发症发生率。结果麻醉诱导前(t_0),两组的SBP、DBP、HR水平无显著差异(P> 0.05);麻醉诱导气管插管时(t_1),观察组SBP、DBP、HR高于对照组(P <0.05);拔除气管导管时(t_2),观察组SBP水平低于对照组,DBP和HR水平均高于对照组(P <0.05);观察组术后呼吸恢复时间、拔管时间明显短于对照组(P <0.05),术后24 h镇痛药用量大于对照组(P <0.05);两组并发症发生率无显著差异(P> 0.05)。结论膀胱癌腹腔镜根治术中,瑞芬太尼与舒芬太尼均有良好的麻醉效果,且并发症发生率低,其中瑞芬太尼术后拔管较早,呼吸恢复更快,而舒芬太尼术后镇痛药物所需用量少。

Objective To compare the anesthetic effects of remifentanil and sufentanil in the patients undergoing laparoscopic radical cystectomy for bladder cancer.MeAods A total of 79 patients with bladder cancer were randomly divided into an observation group(n=40)and a control group(n=39).All patients underwent laparoscopic radical cystectomy for bladder cancer.After the anesthesia induction,the control group was given 0.3μg/L sufentanil combined with 3.0 mg/L propofol to maintain anesthesia,and the observation group was given 0.3μg/L remifentanil combined with 3.0 mg/L propofol to maintain anesthesia.The changes of systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)at different time points,the recovery time of breathing,extubation time and the dosage of analgesics 24 hours after the operation as well as the incidence of complications were compared between the two groups.Results Before anesthesia induction(t0),there was no significant difference in SBP,DBP and HR levels between the two groups(P>0.05);during anesthesia induction tracheal intubation(t1),the SBP,DBP and HR in the observation group were higher than those in the control group(P<0.05);when tracheal intubation was removed⑷,the SBP levels in the observation group were lower than those in the control group,and the DBP and HR levels in the observation group were higher than those in the control group(P<0.05);the recovery time of breathing and extubation time of the observation group were significantly shorter than those of the control group,(P<0.05),while the dosage of analgesics 24 hours after the operation was higher than that of the control group(P<0.05),and there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Remifentanil and sufentanil have good anesthetic effects in laparoscopic radical cystectomy for bladder cancer,and the incidence of complications is low.Remifentanil has earlier extubation and faster respiratory recovery after operation,while sufentanil needs fewer analgesics after operation.