子宫肌瘤腹腔镜术丙泊酚与七氟醚麻醉效果及对血流动力学、应激反应影响

Effect of propofol and sevoflurane for anesthesia during laparoscopic uterine fibroids surgery and their influence on the hemodynamics and stress response

目的:子宫肌瘤腹腔镜手术丙泊酚、七氟醚麻醉效果及对受术者血流动力学及应激反应等的影响。方法:纳入2021年3月-2023年8月本院行腹腔镜手术的子宫肌瘤患者90例,随机数字表法分为丙泊酚组和七氟醚组各45例,分别给予丙泊酚复合瑞芬太尼或七氟醚复合瑞芬太尼麻醉干预。对比两组麻醉效果,干预前后应激反应、血流动力学、认知功能,干预后不良反应。结果:七氟醚组自主呼吸时间(5.26±1.17min)、睁眼时间(7.23±1.13min)及拔管时间(8.57±1.65min)均低于丙泊酚组(7.41±1.28min、9.39±1.34min、10.20±1.79min),干预后两组应激反应、血流动力学及认知功能均有变化,但七氟醚组干预后皮质醇、去甲肾上腺素、葡萄糖水平均低于丙泊酚组,心率、平均动脉压及血氧饱和度低于丙泊酚组,干预后简易精神状态量表评分(28.11±0.40分)高于丙泊酚组(25.43±0.32分),连线实验完成时间(35.67±1.72s)低于丙泊酚组(39.68±1.84s),不良反应发生率(15.6%)低于丙泊酚组(35.6%)(均P<0.05)。结论:子宫肌瘤腹腔镜手术麻醉药物选用七氟醚效果优于丙泊酚,七氟醚对患者应激反应、血流动力学及认知功能影响较小,安全性更高。

Objective:To study the effect of propofol and sevoflurane for anesthesia of patients during laparoscopic uter-ine fibroids surgery,and to analyze their influence on the hemodynamics and stress response of the patients.Methods:90 patients with uterine fibroids who wanted laparoscopic surgery were included and were divided into two groups(45 patients in each group)according to random number table method from March 2021 to August 2023.The patients in group A were given propofol for anesthesia,and the patients in group B were given sevoflurane for anesthesia.The an-esthetic effect,and the stress response,the hemodynamics and the cognitive function before and after anesthesia,and the incidence of adverse events after anesthesia of the patients were compared between the two groups.Results:The time of spontaneous breathing recovery(5.26±1.17 min),the time of opening eye(7.23±1.13 min)and the extuba-tion time(8.57±1.65 min)of the patients in group B were significantly lower than those(7.41±1.28 min,9.39±1.34 min and 10.20±1.79 min)of the patients in group A.The stress response,the hemodynamics and the cognitive func-tion of the patients in the two groups after anesthesia had changed significantly.The levels of cortisol,norepinephrine and glucose of the patients in group B were significantly lower than those of the patients in group A,and the values of heart rate,mean arterial pressure and blood oxygen saturation of the patients in group B were significantly lower.The score of simple mental state scale(28.11±0.40 points)of the patients in group B was significantly higher than that(25.43±0.32 points)of the patients in group A.The completion time of the connected experiment(35.67±1.72s)of the patients in group B was significantly lower than that(39.68±1.84s)of the patients in group A.The incidence of adverse reactions(15.6%)of the patients in group B was significantly lower than that(35.6%)of the patients in group A(all P<0.05).Conclusion:Sevoflurane for anesthesia during laparoscopic surgery of the patients with uterine fi-broids is superior to that of propofol,and which has less influence on the stress response,the hemodynamics and the cognitive function of the patients,with higher safety.