不同血浆靶控浓度阿芬太尼复合瑞马唑仑用于宫腔镜手术对患者血流动力学和呼吸的影响

Effects of different plasma target concentrations of alfentanil combined with remimazolam on hemodynamics and respiration during hysteroscopic surgery

目的比较不同血浆靶控浓度输注(TCI)阿芬太尼复合瑞马唑仑用于宫腔镜手术麻醉对患者血流动力学和呼吸的影响。方法前瞻性选取2022年5月至12月广东医科大学佛山复星禅诚医院择期行宫腔镜手术的患者144例,按照随机数字表法将患者分为4组:TCI 30 ng/mL阿芬太尼组(AR1组)、TCI 40 ng/mL阿芬太尼组(AR2组)、TCI 50 ng/mL阿芬太尼组(AR3组)、TCI 60 ng/mL阿芬太尼组(AR4组),每组各36例。4组分别以相应血浆TCI阿芬太尼,静脉注射瑞马唑仑0.3 mg/kg进行麻醉诱导。各组麻醉维持TCI相应血浆靶控浓度阿芬太尼,恒速泵注瑞马唑仑0.5 mg·kg^(-1)·h^(-1)。比较麻醉诱导前(T_(0))、麻醉诱导后1 min(T_(1))、手术开始时(T_(2))、宫颈扩张时(T_(3))及手术结束时(T_(4))的平均动脉压(MAP)、心率、血氧饱和度(SpO_(2))水平;记录4组患者呼吸抑制、术后疼痛数字分级评分法(NRS)评分≥4分、体动反应、低血压和术后恶心呕吐(PONV)发生情况,并记录4组的手术医师和患者满意度。结果AR1组T_(1)、T_(2)时MAP较AR2组、AR3组、AR4组明显升高,AR4组T_(4)时MAP较AR1组、AR2组、AR3组明显下降,差异均有统计学意义(P<0.05)。各个时间点4组之间的心率比较,差异无统计学意义(P>0.05)。AR4组的呼吸抑制发生率、因缺氧而需要进行气道操作的患者比率均较AR1组、AR2组、AR3组高,差异均有统计学意义(P<0.05)。4组的PONV发生率、术后疼痛评分≥4分的患者比率比较,差异均无统计学意义(P>0.05)。AR1组体动反应发生率较AR2组、AR3组、AR4组明显升高,而AR4组低血压发生率较AR1组、AR2组、AR3组明显升高,差异均有统计学意义(P<0.05)。AR3组、AR4组的手术医师满意度均高于AR1组、AR2组,差异有统计学意义(P<0.05)。4组患者满意度评分,差异无统计学意义(P>0.05)。结论50 ng/mL阿芬太尼复合瑞马唑仑用于宫腔镜手术麻醉较为理想,血流动力学稳定,呼吸抑制少,不良反应发生率低。

Objective To compare the effects of different plasma targeted-concentration infusion(TCI) of alfentanil combined with remimazolam on hemodynamics and respiration during hysteroscopic surgery anesthesia.Methods A total of 144 patients underwent elective hysteroscopic surgery at Foshan Fosun Chancheng Hospital,Guangdong Medical University from May to December 2022,and the patients were divided into 4 groups:plasma TCI of 30 ng/mL alfentanil group(AR1 group),TCI of 40 ng/mL alfentanil group(AR2 group),TCI of 50 ng/mL alfentanil group(AR3 group),and TCI of 60 ng/mL alfentanil group(AR4 group),each group 36 cases.Four groups were anesthetized by target-controlled infusion(TCI) of alfentanil at corresponding plasma concentrations and intravenous injection of 0.3 mg/kg of remimazolam.Each group was anesthetized to maintain the corresponding plasma target concentration of Alfentanil for TCI,and remimazolam 0.5 mg·kg^(-1)·h^(-1) was pumped at a constant rate.The average arterial pressure(MAP),heart rate,and blood oxygen saturation(SpO_(2)) levels were compared before anesthesia induction(T_0),1 minute after anesthesia induction(T_(1)),at the beginning of surgery(T_(2)),during cervical dilation(T_(3)),and at the end of surgery(T_(4));respiratory suppression,postoperative pain numerical rating scale(NRS) score≥4 points,body movement response,hypotension,and PONV occurrence were recorded in 4 groups of patients,and the surgeon and patient satisfaction of the 4 groups of patients were recorded.Results At T_(1) and T_(2),the MAP of AR1 group was significantly higher than that of AR2 group,AR3 group,and AR4 group.At T_(4),the MAP of AR4 group was significantly lower than that of AR1 group,AR2 group,and AR3 group,the differences were statistically significant(P<0.05).There was no statistically significant difference in heart rate between the 4 groups at different time points(P>0.05).The incidence of respiratory depression and the proportion of patients requiring airway operations due to hypoxia in the AR4 group were higher than those in the AR1 group,AR2 group,and AR3 group,the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of postoperative nausea and vomiting(PONV) and the proportion of patients with postoperative pain scores≥4 among the four groups(P>0.05).The incidence of body movement reactions in the AR1 group was significantly higher than that in the AR2,AR3,and AR4 groups,while the incidence of hypotension in the AR4 group was significantly higher than that in the AR1,AR2,and AR3 groups,the differences were statistically significant(P<0.05).The satisfaction of surgeons in AR3 and AR4 groups were higher than those in AR1 and AR2 groups,and the differences were statistically significant(P<0.05).There was no statistically significant difference in satisfaction scores among the four groups(P>0.05).Conclusion 50 ng/mL alfentanil combined with remimazolam is ideal for anesthesia in hysteroscopic surgery,with stable hemodynamics,minimal respiratory suppression,and low incidence of adverse reactions.