七氟烷复合瑞芬太尼对腹腔镜治疗腹股沟疝148例患儿血流动力学的影响

Effect of Sevoflurane Compounded with Remifentanil on the Haemodynamics of 148 Children with Inguinal Hernia Treated Laparoscopically

目的探究七氟烷复合瑞芬太尼对腹腔镜治疗腹股沟疝(IH)患儿血流动力学的影响。方法收集开封市儿童医院296例行腹腔镜治疗IH患儿(2021年3月至2022年3月),按麻醉方案不同分成A组(n=148)、B组(n=148)。A组接受七氟烷复合瑞芬太尼麻醉,B组接受丙泊酚复合瑞芬太尼麻醉。对比两组麻醉前后血流动力学[平均动脉压(MAP)、血氧饱和度、心率(HR)],炎性因子[肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素-6(IL-6)],血清脑源性神经营养因子(BDNF),中枢神经特异蛋白(S100β)水平,麻醉苏醒质量(拔管时间、恢复自主呼吸时间、苏醒时间),不良反应发生率。结果与B组相比,A组气管插管时、切皮后10 min、术毕即刻HR和MAP水平更高(P<0.05);A组拔管时间、恢复自主呼吸时间及苏醒时间更短(P<0.05)。与B组相比,A组切皮后10 min、术毕即刻血清TNF-α、PCT、CRP、IL-6水平更低(P<0.05);A组术毕3 h、6 h血清BDNF水平更高,血清S100β更低(P<0.05)。与B组不良反应总发生率10.14%(15/148)相比,A组2.70%(4/148)更低(P<0.05)。结论相较于丙泊酚复合瑞芬太尼麻醉,腹腔镜治疗IH患儿应用七氟烷复合瑞芬太尼麻醉更有助于提升麻醉苏醒质量,降低机体炎性应激反应,减少不良反应,且对机体血流动力学水平、认知功能影响更小。

Objective To investigate the effect of sevoflurane compounded with remifentanil on the haemodynamics of children with inguinal hernia(IH)treated laparoscopically.Methods A total of 296 children with laparoscopic IH treatment in Kaifeng Children's Hospital(from March 2021 to March 2022)were collected and divided into group A(n=148)and group B(n=148)according to different anesthesia schemes.Group B received propofol combined with remifentanil anesthesia,group A received sevoflurane combined with remifentanil anesthesia.Hemodynamics[mean arterial pressure(MAP),blood oxygen saturation,heart rate(HR)],inflammatory factors[tumor necrosis factor-α(TNF-α),procalcitonin(PCT)]before and after anesthesia were compared between the two groups,C-reactive protein(CRP),interleukin-6(IL-6)],serum brain-derived neurotrophic factor(BDNF),central nervous system specific protein(S100β)levels,anesthesia recovery quality(extubation time,recovery of autonomy)breathing time,wake-up time,incidence of adverse reactions.Results Compared with group B,group A had higher HR and MAP levels during tracheal intubation,10 minutes after skin incision,and immediately after surgery(P<0.05);the extubation time,recovery time of spontaneous breathing and recovery time in group A were shorter(P<0.05).Compared with group B,the levels of serum TNF-α,PCT,CRP and IL-6 in group A were lower 10 minutes after skin incision and immediately after surgery(P<0.05);the level of serum BDNF in group A was higher at 3 h and 6 h after the operation,and the serum S100βwas lower(P<0.05).Compared with the total incidence of adverse reactions in group B,which was 10.14%(15/148),group A was 2.70%(4/148)lower(P<0.05).Conclusion Compared with propofol combined with remifentanil anesthesia,laparoscopic treatment of IH children with sevoflurane combined with remifentanil anesthesia is more helpful to improve the quality of anesthesia recovery,reduce the body's inflammatory stress response,reduce adverse reactions,and have a better effect on the body's hemodynamics.level and cognitive function were less affected.