瑞芬太尼复合丙泊酚麻醉在腹腔镜胆囊切除术治疗急性胆囊炎中的应用

Application of Remifentanil combined with Propofol anesthesia in laparoscopic cholecystectomy for acute cholecystitis

目的探讨接受腹腔镜胆囊切除术治疗急性胆囊炎的患者在手术中使用瑞芬太尼复合丙泊酚进行麻醉的临床效果及对患者血流动力学指标的影响。方法选取2017年6月~2019年6月在沈阳医学院附属中心医院接受腹腔镜胆囊切除术治疗的124例急性胆囊炎患者作为研究对象,按照随机数字表法将其分为观察组与对照组,每组各62例。对照组患者在手术实施时接受瑞芬太尼维持麻醉,观察组患者接受瑞芬太尼复合丙泊酚进行麻醉。比较两组患者的麻醉效果、麻醉质量[镇静评分(Ramsay评分)、运动神经阻滞评分(Bromage评分)、苏醒评分(Steward评分)、视觉模拟量表(VAS)评分]与血流动力学指标[心率(HR)、收缩压(SBP)、舒张压(DBP)、左室射血分数(LVEF)、左心室舒张末压(LVEDd)]。结果观察组患者的麻醉优良率高于对照组,差异有统计学意义(P<0.05)。观察组患者实施麻醉后的Ramsay评分、Bromage评分及Steward评分均高于对照组,VAS评分低于对照组,差异有统计学意义(P<0.05)。麻醉诱导前,两组患者的血流动力学指标比较,差异无统计学意义(P>0.05)。麻醉诱导后,观察组患者的SBP、LVEF及LVEDd低于诱导前,对照组患者的HR、SBP、DBP、LVEF、LVEDd均低于诱导前,差异有统计学意义(P<0.05);麻醉实施后,两组患者的HR、SBP、DBP、LVEF、LVEDd均低于麻醉诱导前,差异有统计学意义(P<0.05);手术后,观察组患者的SBP、DBP及LVEDd低于麻醉诱导前,对照组患者的HR高于麻醉诱导前,SBP、DBP、LVEF、LVEDd均低于麻醉诱导前,差异有统计学意义(P<0.05)。麻醉诱导后、麻醉实施后,观察组患者的HR、SBP、DBP、LVEF及LVEDd均高于对照组,差异有统计学意义(P<0.05);手术后,观察组患者的SBP、DBP、LVEF及LVEDd高于对照组,HR低于对照组,差异有统计学意义(P<0.05)。结论瑞芬太尼复合丙泊酚麻醉在腹腔镜胆囊切除术治疗急性胆囊炎中具有良好的麻醉效果,对患者的麻醉质量较好,且患者血流动力学指标变化程度更小,患者生命体征更加平稳,安全性更高。

Objective To study the clinical effect of Remifentanil combined with Propofol anesthesia in patients undergoing laparoscopic cholecystectomy for acute cholecystitis and its influence on hemodynamic indexes.Methods A total of 124 patients with acute cholecystitis who received laparoscopic cholecystectomy in the Affiliated Central Hospital of Shenyang Medical College from June 2017 to June 2019 were selected as the research objects and divided into the observation group and the control group by random number table method,with 62 cases in each group.Patients in the control group received Remifentanil anesthesia while patients in the observation group received Remifentanil combined with Propofol anesthesia Anesthesia effect,anesthesia quality(sedation score[Ramsay score],motor nerve block score[Bromage score],awakening score[Steward score],visual analogue scale[VAS]score)and hemodynamic indexes(heart rate[HR],systolic blood pressure[SBP],diastolic blood pressure[DBP],left ventricular ejection fraction[LVEF],left ventricular end-diastolic blood pressure[LVEDd])were compared between the two groups.Results The excellent and good rate of anesthesia effect in the observation group(93.55%)was higher than that in the control group(83.87%),and the difference was statistically significant(P<0.05).The Ramsay score,Bromage score and Steward score of the observation group were higher than those of the control group,and the VAS score was lower than that of the control group,the differences were statistically significant(P<0.05).Before anesthesia induction,there were no statistically significant differences in hemodynamic indexes between the two groups(P>0.05).After anesthesia induction,SBP,LVEF and LVEDd in observation group were lower than those before induction,HR,SBP,DBP,LVEF and LVEDd in control group were lower than those before anesthesia induction,and the differences were statistically significant(P<0.05).After anesthesia,HR,SBP,DBP,LVEF and LVEDd of the two groups were lower than those before anesthesia induction,and the differences were statistically significant(P<0.05).After operation,SBP,DBP and LVEDd in the observation group were lower than those before anesthesia induction,HR in the control group was higher than that before anesthesia induction,SBP,DBP,LVEF and LVEDd in the control group were lower than those before induction,and the differences were statistically significant(P<0.05).After anesthesia induction and implementation,HR,SBP,DBP,LVEF and LVEDd in observation group were higher than those in control group,and the differences were statistically significant(P<0.05).After surgery,SBP,DBP,LVEF and LVEDd in observation group were higher than those in control group,HR in observation group was lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion Remifentanil combined with Propofol anesthesia in the treatment of acute cholecystitis in laparoscopic cholecystectomy has good anesthetic effect,good quality of anesthesia for patients,postoperative recovery is also good,and the degree of hemodynamic changes in patients is smaller,the patient′s vital signs are more stable,and the safety is higher.