异丙酚瑞芬太尼靶控输注麻醉对子宫肌瘤手术患者血流动力学及氧化应激的影响

Effect of target-controlled infusion of propofol and remifentanil on hemodynamics and oxidative stress of patients undergoing uterine fibroids surgery

目的探讨异丙酚、瑞芬太尼靶控输注麻醉对子宫肌瘤手术患者血流动力学及氧化应激的影响。方法将行子宫肌瘤切除术的112例患者按麻醉方式不同分为两组,每组56例。对照组采取芬太尼复合七氟烷吸入麻醉,研究组采取异丙酚、瑞芬太尼靶控输注麻醉。比较两组不同时点血流动力学指标(平均动脉压、心率)、围术期(术前、术后1 d、术后3 d)氧化应激指标(脂质过氧化氢、谷胱甘肽过氧化物酶)、麻醉效果(麻醉起效时间、自主呼吸恢复时间、苏醒时间、拔管时间)及不良反应发生率。结果气腹后30 min、拔管后3 min研究组平均动脉压、心率显著低于对照组(P<0.01),麻醉前、手术结束即刻两组比较差异无统计学意义(P>0.05)。研究组麻醉起效时间、自主呼吸恢复时间、苏醒时间、拔管时间均显著早于对照组(P<0.01)。术前及术后3 d两组血清脂质过氧化氢、谷胱甘肽过氧化物酶水平比较差异无统计学意义(P>0.05);术后1 d研究组血清脂质过氧化氢水平显著低于对照组(P<0.05),血清谷胱甘肽过氧化物酶水平显著高于对照组(P<0.01)。研究组不良反应发生率虽低于对照组,但差异无统计学意义(P>0.05)。结论对子宫肌瘤手术患者采用异丙酚、瑞芬太尼靶控输注麻醉,能确保血流动力学平稳,减轻氧化应激损伤,缩短麻醉起效时间,提高苏醒质量,安全性高。

Objective To observe the effect of target-controlled infusion of propofol and remifentanil on hemodynamics and oxidative stress of patients undergoing uterine fibroids surgery.Methods A total of 112 patients with uterine fibroids were divided into two groups according to different anesthesia methods,with 56 cases in each group.The control group received fentanyl combined with sevoflurane inhalation anesthesia,while the study group received target-controlled infusion of propofol and remifentanil.The hemodynamic indexes[mean arterial pressure(MAP),heart rate(HR)],perioperative oxidative stress indexes[lipid hydrogen peroxide(LHP),glutathione peroxidase(GSH-PX)]before surgery,1 day after surgery,3 days after surgery,anesthetic effect(anesthetic onset time,spontaneous breathing recovery time,wake-up time,extubation time)and the incidence of adverse reactions were compared between the two groups at different time points.Results The MAP and HR at T1 and T2 of the study group were significantly lower than those of the control group(P<0.01).There was no significant difference between the two groups before anesthesia and immediately after surgery(P>0.05).The anesthesia onset time,spontaneous breathing recovery time,wake-up time,and extubation time of the study group were significantly earlier than those of the control group(P<0.01).There was no significant difference in serum LHP and GSH-PX levels between the two groups before and three days after surgery(P>0.05).One day after operation,the serum LHP level of the study group was significantly lower than that of the control group(P<0.05),and the serum GSH-PX level was significantly higher than that of the control group(P<0.01).Although the incidence of adverse reactions in the study group was lower than that in the control group,the difference was not statistically significant(P>0.05).Conclusions Target-controlled infusion with propofol and remifentanil in patients with uterine fibroids can ensure stable hemodynamics and reduce oxidative stress injury,shorten the onset time of anesthesia,improve the quality of recovery,and have high safety.