瑞芬太尼靶控输注对结直肠癌根治术患者麻醉效果及安全性的影响

Impact of Target-controlled Infusion of Remifentanil on Anesthetic Effect and Safety in Patients Undergoing Radical Resection of Colorectal Cancer

目的探讨瑞芬太尼靶控输注与持续静脉输注对结直肠癌根治术患者麻醉效果及安全性的影响。方法选取2019年5月—2021年5月收治的结直肠癌90例,按麻醉方法分为A、B组各45例,2组均行结直肠癌根治术,术中复合麻醉时A组予以瑞芬太尼靶控输注,B组予以瑞芬太尼持续静脉输注。比较2组围术期生命体征、麻醉前后应激反应、麻醉后镇痛效果、麻醉苏醒情况、瑞芬太尼及异丙酚用量、围术期不良反应发生情况。结果A组诱导后、术后10 min舒张压、收缩压及心率均低于B组,麻醉后3 h肾上腺素、去甲肾上腺素、皮质醇均低于B组,拔管10 min警觉/镇静评分、躁动评分及术后6 h视觉模拟评分法评分均低于B组,自主呼吸恢复、呼之睁眼、完成指令及拔管时间均短于B组,瑞芬太尼、异丙酚用量少于B组(P<0.05,P<0.01)。2组术中、术后不良反应发生率比较差异无统计学意义(P>0.05)。结论瑞芬太尼靶控输注在平稳结直肠癌患者围术期生命体征,降低应激反应,早期苏醒及减少麻醉药物剂量方面效果显著。

Objective To investigate the impact of target-controlled infusion and continuous intravenous infusion of Remifentanil on the anesthetic effect and safety of patients undergoing radical resection of colorectal cancer(CRC).Methods A total of 90 patients with CRC who were treated from May 2019 to May 2021 were selected and divided into group A(n=45)and group B(n=45)according to the anesthesia method.Both groups underwent radical resection of CRC.During the intraoperative compound anesthesia,group A received target-controlled infusion of Remifentanil,and group B received continuous intravenous infusion of Remifentanil.Perioperative vital signs,stress response before and after anesthesia,analgesic effect after anesthesia,recovery from anesthesia,dosage of Remifentanil and Propofol,and perioperative adverse reactions were compared between the two groups.Results The diastolic blood pressure,systolic blood pressure and heart rate of group A were lower than those of group B after induction and at 10 min after operation,and epinephrine,norepinephrine,and cortisol were lower than those of group B at 3 h after anesthesia.The alertness/sedation score,restlessness score and visual analog scale score at 6 h after operation were lower than those in group B,the recovery of spontaneous breathing,eye opening,completion of instructions and extubation time were all shorter than those in group B,and the dosage of Remifentanil and Propofol was less.than that in group B(P<0.05,P<0.01).There was no significant difference in the incidence of adverse reactions during and after operation between the two groups(P>0.05).Conclusion Intravenous target-controlled infusion of Remifentanil is effective in stabilizing the perioperative vital signs of patients with CRC,reducing stress response,early recovery and reducing the dose of anesthetics.