七氟烷和瑞芬太尼在老年前列腺等离子电切术麻醉中的应用效果观察和血流动力学比较

Effect observation and hemodynamic comparison of sevoflurane and remifentanil in plasma electrosurgical anesthesia of elderly prostates

目的结合临床实践经验,探讨七氟烷和瑞芬太尼在老年前列腺等离子电切术麻醉中的应用效果和血流动力学状态变化情况.方法选取2021年12月-2022年10月邵东宋家塘佰骏医院收治的行老年前列腺等离子电切术患者112例,根据随机数字表法分为七氟烷组和瑞芬太尼组,术中分别使用七氟烷和瑞芬太尼静脉滴注维持麻醉,比较两组患者麻醉相关指标,并对两组患者不同苏醒时间VAS疼痛评分进行比较,比较两组患者不同时间点血流动力学指标,并观察两组患者并发症发生情况.结果七氟烷组患者苏醒时间、拔管时间、呼吸恢复时间和拔管时OAA/S评分均少(短)于瑞芬太尼组,差异有统计学意义(均P=0.000).七氟烷组患者苏醒时、苏醒0.5h后、苏醒1h后和苏醒2h后VAS疼痛评分均明显低于瑞芬太尼组,差异有统计学意义(均P=0.000).七氟烷组和瑞芬太尼组患者在T0、T2、T3和T4时间点MAP和HR水平差异无统计学意义(P>0.05);T1时间点七氟烷组患者MAP和HR水平均明显高于瑞芬太尼组,差异有统计学意义(P<0.05).七氟烷组患者并发症发生率(3.57%)明显低于瑞芬太尼组(16.07%),差异有统计学意义(χ^(2)=4.940,P=0.026).结论相比于瑞芬太尼,在行老年前列腺等离子电切术麻醉中使用七氟烷可缩短患者苏醒时间和拔管时间,减轻苏醒后VAS评分,保持血流动力学稳定,减轻术后躁动等并发症,值得进一步推广应用.

Objective Combined with clinical experience,the effects of sevoflurane and remifentanil in plasma electrosurgical anesthesia of elderly prostate were studied and the changes of hemodynamics were discussed.Methods A total of 112 elderly patients undergoing plasma resection of prostate in our hospital from December 2021 to October 2022 were selected and divided into sevoflurane group and remifentanil group according to random number table method.Sevoflurane and remifentanil intravenous infusion were used to maintain anesthesia during the operation,respectively,and anesthesia-related indicators were compared between the two groups.VAS pain scores at different wake times were compared between the two groups,hemodynamic indexes at different time points were compared between the two groups,and the occurrence of adverse reactions in the two groups were observed.Results The recovery time,extubation time,respiratory recovery time and OAA/S score at extubation in sevoflurane group were less(shorter)than those in remifentanil group,and the differences were statistically significant(all P=0.000).VAS pain scores of sevoflurane group were significantly lower than remifentanil group at the time of recovery,0.5h after recovery,Ih after recovery and 2h after recovery,with statistical significance(all P=0.000).There was no significant difference in MAP and HR levels between sevoflurane group and remifentanil group at TO,T2,T3 and T4 time points(P>0.05).MAP and HR levels in sevoflurane group were significantly higher than remifentanil group at TI time,with statistical significance(P<0.05).The incidence of complications in sevoflurane group(3.57%)was significantly lower than remifentanil group(16.07%),and the difference was statistically significant(χ^(2)=4.940,P=-0.026).Conclusion Compared with remifentanil,sevoflurane can shorten the recovery time and extubation time of patients during plasma resection of prostate in elderly patients,reduce the VAS score after recovery,maintain stable hemodynamics,and reduce postoperative restfulness and other complications,which is worthy of further promotion and application.