不同麻醉药物对妇科腹腔镜术患者血流动力学、术中指标及预后影响

Influence of different anesthetic drugs used in gynecological laparoscopic surgery on intraoperative hemodynamics and indexes,and prognosis

目的:分析妇科腹腔镜手术中应用不同麻醉药物对患者血流动力学、术中指标及预后的影响。方法:回顾性分析2018年1月-2022年12月在本院行腹腔镜下卵巢囊肿剔除术患者78例临床资料,按照术中麻醉药物使用不同分为瑞芬太尼组(n=40)、枸橼酸芬太尼组(n=38),观察两组麻醉前(T0)、诱导后(T1)、插管时(T2)、切皮时(T3)、拔管时(T4)的心率(HR)、收缩压(SBP)、舒张压(DBP)变化情况,麻醉维持时间、苏醒时间、拔管时间及初次镇痛时间;采用警觉/镇静观察(OAA/S)评分与视觉模拟疼痛量表(VAS)评估患者术后意识状态及疼痛程度;绘制Kaplan-Meier生存曲线观察两组镇痛后48h内不良反应发生情况;采用本院自拟满意度量表调查两组麻醉满意度。结果:术中不同时间点观察显示,枸橼酸芬太尼组术中HR、SBP、DBP变化稳定程度均优于瑞芬太尼组;瑞芬太尼组麻醉维持时间(97.59±15.05min)长于枸橼酸芬太尼组(85.36±8.27min),苏醒时间(5.40±0.87min)、拔管时间(6.51±0.86min)及初次阵痛时间(10.50±0.87min)均短于枸橼酸芬太尼组(13.09±1.81min、18.67±1.62min、53.68±7.84min),术后苏醒时OAA/S评分(2.88±0.76分)高于枸橼酸芬太尼组(1.92±0.85分)(均P<0.05),但术后48h VAS评分两组无差异;瑞芬太尼组术后不良反应总发生(5.0%)低于枸橼酸芬太尼组(26.3%),麻醉满意度(77.5%)高于枸橼酸芬太尼组(52.6%)(均P<0.05)。结论:相比于瑞芬太尼,枸橼酸芬太尼更能够保持患者麻醉状态下的血流动力学稳定,但瑞芬太尼术后恢复时间优于枸橼酸芬太尼,且镇痛时间短于枸橼酸芬太尼,因此在使用瑞芬太尼时术后需及时注意患者的镇痛需求。

Objective:To analyze the influence value of the different anesthetic drugs used in gynecological laparoscopic surgery of patients on their intraoperative hemodynamics and indexes,and their prognosis.Methods:The clinical data of 78 patients who had undergone laparoscopic ovarian cyst excision from January 2018 to December 2022 were ana-lyzed retrospectively.According to the intraoperative anesthetic drugs used,these patients were divided into 40 patients with remifentanil for anesthetic in group A and 38 patients with fentanyl citrate for anesthetic in group B.The value changes of heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),the anesthetic mainte-nance time,the awakening time,the extubation time,and the initial analgesia time of the patients in the two groups before anesthesia(T0),after induction(T1),during intubation(T2),at skin resection(T3),and at extubation(T4)were observed.The alertness/sedation observation(OAA/S)score and the pain score by visual analogue scale(VAS)were used to evaluate the postoperative consciousness and pain degree of the patients.Kaplan-Meier survival curve was drawn to observe the occurrence of the adverse reactions of the patients in the two groups within 48h after analgesia.The anesthesia satisfaction of the patients in the two groups was investigated by the self-designed satisfaction scale.Results:The observations for the patients at different time points during operation showed that the stability of the HR,SBP,and DBP values of the patients in group A were significantly better than those of the patients in group B.The duration of anesthesia(97.59±15.05min)of the patients in group A was significantly longer than that(85.36±8.27min)of the patients in group B.The awakening time(5.40±0.87 min),the extubation time(6.51±0.86min),and the first pain duration(10.50±0.87 min)of the patients in group A were significantly shorter than those(13.09±1.81 min.18.67±1.62min,and 53.68±7.84min)of the patients in group B.The OAA/S score(2.88±0.76 points)of the patients in group A at postoperative awaking was significantly higher than that(1.92±0.85 points)of the patients in group B(P<0.05),but there was no significant difference in the VAS score of the patients at 48h after surgery be-tween the two groups.The total occurrence of postoperative adverse reactions(5.0%)of the patients in group A was significantly lower than that(26.3%)of the patients in group B,and the rate of anesthesic satisfaction(77.5%)of the patients in group A was significantly higher than that(52.6%)of the patients in group B(all P<0.05).Conclusion:Compared with those of remifentanil,fentanyl citrate can maintain the hemodynamic stability of the patients under an-esthesia.The postoperative recovery time of the patients with remifentanil for anesthesia is significantly better than that of fentanyl citrate,and the analgesic time is significantly shorter,so it is necessary to pay attention to the analge-sic needs after surgery of the patients with remifentanil for anesthesia.