腹腔镜妇科手术患者麻醉诱导前静脉推注纳美芬对围术期炎症反应的影响

The effect of intravenous injection of nalmefene before anesthesia induction on perioperative inflammatory response in patients undergoing laparoscopic gynecological surgery

目的 分析腹腔镜妇科手术患者麻醉诱导前静脉推注纳美芬对围术期炎症反应的影响。方法 回顾性分析2020年1月至2022年1月河北省沧州市人民医院收治的60例腹腔镜妇科手术患者的临床资料,根据麻醉方法不同将研究对象分为对照组(麻醉诱导前15min给予生理盐水)和试验组(麻醉诱导前15min静脉推注纳美芬),每组30例。比较分析两组患者进入手术室时(T_(0))、建立气腹时(T_(1))、建立气腹后60min (T_(2))、建立气腹后120min (T_(3))、气腹结束时(T_(4))、离开手术室时(T_(5))的血流动力学水平,T_(0)、T_(5)时刻的炎症因子水平,麻醉相关指标,以及术后24h的认知功能障碍、低氧血症发生情况。结果 与T_(0)时刻比较,试验组患者T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时刻的舒张压、收缩压、心率均显著降低(P.<0.05),且T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时刻,试验组患者的舒张压、收缩压、心率均显著低于对照组(P<0.05)。与T_(0)时刻比较,两组患者T_(5)时刻的降钙素原、超敏C反应蛋白、白介素-6水平均显著升高(P<0.05),且对照组显著高于试验组(P<0.05)。试验组患者的睁眼时间、意识恢复时间、自主呼吸恢复时间、导管拔除时间均显著短于对照组(P<0.05)。试验组患者术后24h的认知功能障碍发生率以及低氧血症发生率均显著低于对照组(P<0.05)。结论 腹腔镜妇科手术患者麻醉诱导前静脉推注纳美芬可维持术中血流动力学水平稳定,减轻炎症反应,降低认知功能障碍、低氧血症发生率。

Objective To analyze the effect of intravenous injection of nalmefene before anesthesia induction on perioperative inflammatory response in patients undergoing laparoscopic gynecological surgery.Method The clinical data of 60 patients with laparoscopic gynecological surgery treated in Cangzhou People’s Hospital from January 2020 to January 2022 were retrospectively analyzed.According to different anesthesia methods,they were divided into control group(given normal saline 15min before anesthesia induction)and experimental group(intravenous injection of nalmefene 15min before anesthesia induction),with 30 cases in each group.Hemodynamic levels when entering the operating room(T0),establishing pneumoperitoneum(T1),60min after establishing pneumoperitoneum(T2),120min after establishing pneumoperitoneum(T3),at the end of pneumoperitoneum(T4),leaving the operating room(T5),inflammatory factors at T0 and T5,related indexes of anesthesia,the incidence of cognitive dysfunction and hypoxemia 24h after surgery in the two groups were compared.Result Compared with T0,the DBP,SBP,HR at T1,T2,T3,T4 and T5 in experimental group were significantly decreased(P<0.05),and the DBP,SBP,HR at T1,T2,T3,T4 and T5 were significantly lower than those in control group(P<0.05).Compared with T0,the PCT,hs-CRP,IL-6 in two groups were significantly increased at T5(P<0.05),and the control group was significantly higher than the experimental group(P<0.05).The eye opening time,consciousness recovery time,spontaneous breathing recovery time and catheter removal time in experimental group were significantly shorter than those in control group(P<0.05).The incidence of cognitive dysfunction and hypoxemia 24h after surgery in experimental group were significantly lower than those in control group(P<0.05).Conclusion Intravenous injection of nalmefene before anesthesia induction in laparoscopic gynecological surgery can maintain the stability of intraoperative hemodynamic level,relief inflammatory response,reduce the incidence of cognitive dysfunction and hypoxemia.