瑞芬太尼联合丙泊酚麻醉在心脏病患者手术中的应用

Application of Remifentanil combined with Propofol anesthesia in operation of patients with cardiac diseases

目的探讨瑞芬太尼联合丙泊酚麻醉在心脏病患者手术中的应用效果。方法选取2016年12月~2018年12月广东省高州市人民医院收治的60例心脏病手术治疗患者作为研究对象,按照不同麻醉方法将其分为对照组与观察组,每组各30例。对照组患者采用芬太尼联合丙泊酚麻醉方法,观察组患者采用瑞芬太尼联合丙泊酚麻醉方法。比较两组患者T0(麻醉诱导前)、T1(麻醉诱导后)、T2(体外循环后10 min)、T3(手术结束后)等时间点的血流动力学变化情况、在ICU的观察时间、拔管时间、住院时间及不同时间点白介素-6β(IL-6β)、细胞间黏附分子-1(ICAM-1)和C反应蛋白(CRP)水平。结果两组患者T1、T2、T3时的平均动脉压(MAP)和心率(HR)与T0时比较,差异有统计学意义(P<0.05)。观察组患者T1、T2、T3时的MAP高于对照组,差异有统计学意义(P<0.05);观察组患者T1时的HR高于对照组,差异有统计学意义(P<0.05);观察组患者T2、T3时的HR低于对照组,差异有统计学意义(P<0.05)。观察组患者的ICU观察时间、拔管时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。麻醉3 d后,两组患者的IL-6β、ICAM-1和CRP水平低于麻醉6 h后,差异有统计学意义(P<0.05);麻醉3 d后,观察组患者的IL-6β、ICAM-1和CRP水平均低于对照组,差异有统计学意义(P<0.05)。结论在心脏病患者手术中使用瑞芬太尼联合丙泊酚麻醉,可改善其血流动力学,缩短ICU观察时间、拔管时间、住院时间,降低IL-6β、ICAM-1和CRP水平,应用价值较高。

Objective To investigate the effect of Remifentanil combined with Propofol anesthesia in operation of patients with cardiac diseases.Methods A total of 60 patients with cardiac diseases who underwent cardiac surgery in People′s Hospital of Gaozhou from December 2016 to December 2018 were selected as the research objects.According to different anesthesia methods,they were divided into the control group and the observation group,with 30 cases in each group.The control group was anesthetised with Fentanyl combined with Propofol,and the observation group was anesthetised with Remifentanil combined with Propofol.The hemodynamic changes at T0(before induction of anesthesia),T1(after induction of anesthesia),T2(10 min after cardiopulmonary bypass),T3(after surgery),the intensive care unit(ICU)observation time,extubation time,hospitalization time,levels of interleukin-6β(IL-6β),intercellular adhesion molecule-1(ICAM-1)and C reactive protein(CRP)at different time were compared between the two groups.Results The mean arterial pressure(MAP)and heart rate(HR)at T1,T2 and T3 were compared with those at T0,and the differences were statistically significant(P<0.05).The MAP at T1,T2 and T3 in observation group were higher than those in control group,and the differences were statistically significant(P<0.05).The HR at T1 in observation group was higher than that in control group,and the difference was statistically significant(P<0.05).The HR of observation group at T2 and T3 was lower than that of control group,and the difference was statistically significant(P<0.05).The ICU observation time,extubation time and hospitalization time of the observation group were shorter than those of the control group,and the differences were statistically significant(P<0.05).After 3 days of anesthesia,the levels of IL-6β,ICAM-1 and CRP in the two groups were lower than those after 6 hours of anesthesia,and the differences were statistically significant(P<0.05).After 3 days of anesthesia,the levels of IL-6β,ICAM-1 and CRP in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The use of Remifentanil combined with Propofol in cardiac surgery can improve the hemodynamics,shorten the ICU observation time,extubation time,hospitalization time,and reduce the levels of IL-6β,ICAM-1 and CRP,which has a high application value.