气管插管前应用瑞芬太尼预处理对胸腔镜手术患者血流动力学和术后镇痛效果的影响

Effect of pretreatment with remifentanil before tracheal intubation on hemodynamics and postoperative analgesia in patients undergoing thoracoscopic surgery

目的探究气管插管前应用瑞芬太尼预处理对胸腔镜手术患者血流动力学和术后镇痛效果的影响。方法抽取2019年6月至2020年12月在焦作煤业集团有限责任公司中央医院接受胸腔镜手术治疗的患者138例,采用随机数字表法分为观察组和对照组。观察组70例患者气管插管前静脉注射瑞芬太尼预处理,对照组68例患者注射等量生理氯化钠溶液。检测并比较两组插管前后血流动力学指标参数及应激水平。术后第1、2、3天,采用视觉模拟评分法(VAS)评估两组患者的疼痛程度。记录两组术后并发症发生情况。结果插管置入后,观察组心率、平均动脉压均低于对照组(P均<0.05),肾上腺素浓度高于对照组(P<0.05),皮质醇浓度低于对照组(P<0.05)。术后第1、2、3天,观察组VAS评分均低于对照组(P均<0.05)。观察组术后并发症总发生率(7.14%,5/70)低于对照组(19.12%,13/68),P<0.05。结论胸腔镜手术患者气管插管前给予瑞芬太尼预处理可降低对患者血流动力学的影响,缓解机体应激水平和术后疼痛,降低术后并发症发生率。

Objective To investigate the effect of pretreatment with remifentanil before tracheal intubation on hemodynamics and postoperative analgesia in patients undergoing thoracoscopic surgery.Methods A total of 138 patients undergoing thoracoscopic surgery in Central Hospital of Jiaozuo Coal Industry Group Co.,Ltd.from June 2019 to December 2020 were selected.They were divided into observation group and control group by random number table method.The observation(70 cases)group received pretreatment with intravenous injection of remifentanil before tracheal intubation,and the control group(68 cases)received the same dose of physiological sodium chloride solution.The hemodynamic parameters and stress levels of the two groups before and after intubation were compared.The visual analogue scale(VAS)was used to evaluate pain degree of the two groups on the first,second,and third day after operation.And postoperative complications of the two groups were recorded.Results After intubation,the heart rate and mean arterial pressure of the observation group were lower than those of the control group(all P<0.05),and the concentration of epinephrine was higher than that of the control group(P<0.05),and the concentration of cortisol was lower than that in the control group(P<0.05).The VAS scores of the observation group were lower than those of the control group on the 1st,2nd and 3rd day after operation(all P<0.05).The total incidence of postoperative complications in the observation group(7.14%,5/70)was lower than that in the control group(19.12%,13/68),P<0.05.Conclusions Pretreatment with remifentanil before tracheal intubation can significantly reduce the impact on hemodynamics,relieve the stress level and postoperative pain,and reduce the incidence of postoperative complications in patients undergoing thoracoscopic surgery.