瑞芬太尼对腹腔镜子宫肌瘤切除术患者应激反应和认知功能的影响

Effects of remifentanil on stress response and cognitive function in patients undergoing laparoscopic myomectomy

目的探讨瑞芬太尼对腹腔镜子宫肌瘤切除术患者应激反应和认知功能的影响。方法选取2018年1月至2019年10月间西北妇女儿童医院收治的144例子宫肌瘤患者,采用随机数字表法分为观察组和对照组,每组72例。两组患者均行腹腔镜下子宫肌瘤切除术,对照组患者采用芬太尼进行麻醉,观察组患者采用瑞芬太尼麻醉,比较两组患者的应激反应及术后认知功能情况。结果T1时,两组患者肾上腺素(A)和去甲肾上腺素(NA)水平比较,差异无统计学意义(P>0.05)。T2和T3时,两组患者A和NA水平均上升,但观察组均低于对照组,差异均有统计学意义(均P<0.05)。术前,两组患者简易智力状态检查量表(MMSE)评分和连线测试(TMT)完成时间比较,差异无统计学意义(P>0.05),且其水平均在标准范围内。术后,观察组患者MMSE评分高于对照组,TMT完成时间低于对照组,差异均有统计学意义(均P<0.05)。结论子宫肌瘤患者术中采用瑞芬太尼麻醉,可维持较好的麻醉时间,减轻患者应激反应,减轻对患者认知水平的影响,值得应用和推广。

Objective To investigate the effect of remifentanil on stress response and cognitive function in patients undergoing laparoscopic myomectomy.Methods One hundred and forty-four patients with uterine leiomyoma who were admitted at Northwest Women and Children’s Hospital from January 2018 to October 2019 were selected as the research subjects.They were divided into an observation group and a control group using random number table method with 72 patients in each group.Patients in the observation group were anesthetized with remifentanil and patients in the control group were anesthetized with fentanyl.Postoperative stress response and cognitive status were compared between the two groups.Results There was no significant difference in the levels of adrenaline and noradrenaline between the two groups at T1(P>0.05).The levels of adrenaline and noradrenaline were increase in both groups at T2 and T3 with the observation group lower in the control group(all P<0.05).There was no significant difference in mini mental state examination(MMSE)scores and trail making test(TMT)time between the two groups before the surgery(P>0.05).However,after the surgery,MMSE scores were higher in the observation group than in the control group and TMT time was shorter in the observation group than in the control group(all P<0.05).Conclusion Anesthesia with remifentanil can maintain anesthesia time,and reduce stress response and the impact on the cognitive level.It is worthy of application and promotion.