七氟烷复合瑞芬太尼在肥胖腹腔镜袖状胃切除患者中的麻醉效果

Anesthetic effects of Sevoflurane combined with remifentanil on obese patients undergoing laparoscopic sleeve gastrectomy

目的探讨七氟烷复合瑞芬太尼在肥胖患者腹腔镜下袖状胃切除术中的麻醉效果及其安全性。方法选取2017年1月—2020年4月本院收治的拟行腹腔镜下袖状胃切除术患者40例作为研究对象,随机分为七氟烷组(S组)和丙泊酚组(P组)两组,每组各20例。两组患者进行相同方式的麻醉诱导和气管插管后,S组患者使用七氟烷复合瑞芬太尼进行麻醉维持,P组患者使用丙泊酚复合瑞芬太尼进行麻醉维持。所有患者均在四个成串刺激(TOF)肌松监测下间断静注肌松药物罗库溴铵维持肌松,在手术室内拔除气管导管后送至麻醉恢复室(PACU)监测治疗后送返普通病房。记录两组患者麻醉时间、苏醒时间、拔管时间以及PACU治疗时间;记录患者拔管后不同时间点患者的警觉-镇静(OAA/S)评分;记录拔管后不同时间点患者的脉氧饱和度(Sp O2);观察并记录两组患者苏醒期不良反应发生情况。结果S组患者瑞芬太尼和罗库溴铵的使用剂量低于P组(P<0.05);S组患者睁眼时间、拔管时间、定向力恢复时间和PACU治疗时间较P组短(P<0.05);S组患者拔管后各时间点脉氧饱和度高于P组(P<0.05);拔管后10 min(T1)和拔管后20 min(T2),S组患者的OAA/S评分低于P组即镇静水平与P组相比较低(P<0.05);两组患者苏醒期疼痛、躁动、恶心及呕吐的发生率进行比较,差异无统计学意义(P>0.05)。结论七氟烷复合瑞芬太尼用于肥胖患者腹腔镜下袖状胃切除术麻醉的维持,麻醉效果确切、苏醒快且术后恢复质量高,安全有效。

Objective To evaluate the anesthetic effectiveness and safety of Sevoflurane combined with remifentanil on obese patients undergoing laparoscopic sleeve gastrectomy.Methods 40 patients who were will undergoing laparoscopic sleeve gastrectomy(admitted to our hospital from January 2017 to April 2020)were divided into two groups randomly:sevoflurane group(group S,n=20),and propofol group(group P,n=20).After performing the anesthesia induction and tracheal intubation in the same way,maintenance of anesthesia of patients in two groups was achieved by sevoflurane inhalation combined with remifentanil intravenous pumping(Group S)or propofol-remifentanil intravenous pumping(Group P).All patients received intermittent intravenous injection of the muscle relaxant rocuronium to maintain muscle relaxations under train-of four stimuli(TOF).All patients recovered and were extubated in operation room,and then the patients were transferred to PACU for further monitoring and treatment.The duration of anesthesia,the recovery time,extubation time and the time of treatment in PACU were recorded.Scores of Observer’s Assessment of Alertness/Sedation Scale(OAA/S)and Sp O2 at different time points after extubation were recorded and analyzed.The side effects of anesthesia during recovery period in both groups were recorded.Results The consumption of remifentanil and rocuronium was lower in Group S than that in Group P(P<0.05).The recovery time(eye opening,extubation,recovery orientation)and the time of treatment in PACU in group S were shorter than those in group P(P<0.05).Sp O2 in group S were higher than those in group P at all the three time points(P<0.05),and OAA/S scores in group S were lower than those in group P at 10 minutes and 20 minutes after extubation(P<0.05).No significant differences were observed between the two groups in terms of the incidence of pain,agitation,nausea and vomiting during the recovery period.Conclusions The use of sevoflurane combined with remifentanil has exact effect of anesthesia,rapid emergence,high-quality postoperative recovery and low incidence of side effect.So it is worth being used widely on the obese patients undergoing laparoscopic sleeve gastrectomy.