不同靶浓度的瑞芬太尼对胸外科手术患者应激反应和肺功能的影响

Effects of different target concentrations of remifentanil on stress response and lung function in patients undergoing thoracic surgery

目的:探讨不同靶浓度的瑞芬太尼对胸外科手术患者应激反应和肺功能的影响。方法:选取近年来在昆明市中医医院进行胸外科手术的45例患者作为研究对象。随机将其分为A组、B组、C组。术中分别为A组、B组、C组患者静脉泵注靶浓度为4μg/L、6μg/L、8μg/L的瑞芬太尼进行麻醉维持,然后比较三组患者的应激反应指标、肺功能指标及视觉模拟评分法(VAS)的评分。结果:术后第1天,C组患者的白细胞(WBC)计数和血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、淀粉样蛋白A(SAA)的水平均低于A组患者与B组患者,P<0.05;B患者的WBC计数和血清CRP、IL-6、SAA的水平均低于A组患者,P<0.05。术后3个月,C组患者的呼气峰值流速(PEF)、用力肺活量(FVC)和一秒钟用力呼气容积(FEV1)均高于A组患者与B组患者,P<0.05;B患者的PEF、FVC和FEV1均高于A组患者,P<0.05。术后6 h,C组患者的VAS评分低于A组患者与B组患者,P<0.05;B组患者的VAS评分低于A组患者,P<0.05。结论:在采用瑞芬太尼对接受胸外科手术的患者进行麻醉维持时,提高其靶浓度可有效减轻患者术后的应激反应和疼痛的程度,改善其肺功能。

Objective:To investigate the effects of different target concentrations of remifentanil on stress response and lung function in patients undergoing thoracic surgery.Methods:45 patients who underwent thoracic surgery in Kunming Hospital of Traditional Chinese Medicine in recent years were selected as the research object.They were randomly divided into group A,group B and group C.Intraoperative anesthesia was maintained with remifentanil at 4μg/L,6μg/L and 8μg/L intravenously pumped in group A,group B and group C,respectively,and the stress response indexes,pulmonary function indexes and visual analog scale(VAS)scores of the three groups were compared.Results:On the 1st postoperative day,the white blood cell(WBC)count and the serum levels of C-reactive protein(CRP),interleukin-6(IL-6)and amyloid A(SAA)in group C were lower than those in group A and group B,P<0.05;The WBC count and serum CRP,IL-6 and SAA levels of patients B were lower than those of group A,P<0.05.3 months after surgery,the peak expiratory flow rate(PEF),forced vital capacity(FVC)and forced expiratory volume one second(FEV1)in group C were higher than those in group A and group B,P<0.05;PEF,FVC and FEV1 in patients B were higher than those in group A,P<0.05.6 h after surgery,VAS score of group C was lower than that of group A and group B,P<0.05;VAS score of group B was lower than that of group A,P<0.05.Conclusion:When remifentanil is used for anesthesia maintenance in patients undergoing thoracic surgery,increasing its target concentration can effectively reduce postoperative stress response and pain degree,and improve lung function.