腹腔镜子宫切除手术瑞芬太尼联合丙泊酚镇痛效果及对患者血流动力学、应激指标影响

Analgesic effect of remifentanil combined with propofol used in laparoscopic hysterectomy and its influence on the hemodynamics and stress indexes

目的:探究腹腔镜子宫切除术应用瑞芬太尼联合丙泊酚麻醉镇痛效果及对患者血流动力学、应激指标和不良反应影响。方法:选取本院2021年1月-2023年12月接诊的拟行腹腔镜子宫切除术患者128例,随机分为观察组和对照组(均n=64),均行腹腔镜子宫切除术,术中对照组予以舒芬太尼联合丙泊酚麻醉诱导,随后持续泵入维持;观察组予以瑞芬太尼联合丙泊酚麻醉诱导,随后持续泵入维持。对比两组血流动力学指标、应激指标、疼痛指标、疼痛视觉模拟评分(VAS)及不良反应。结果:麻醉诱导后、气管插管时、手术开始时及手术结束即刻心率和平均动脉压水平观察组均低于对照组,术后即刻两组肾上腺素、皮质醇、5-羟色胺和脑内神经肽水平均低于术前且观察组(60.26±5.41 pg/ml、84.22±5.03ng/ml、90.24±9.31ng/L、121.69±13.47μg/L)低于对照组(69.96±5.15pg/ml、92.15±6.39ng/ml、139.64±12.13ng/L、160.55±16.36μg/L),两组术后即刻疼痛评分均低于术前,且观察组(2.95±0.21分)低于对照组(3.37±0.32分)(均P<0.05);不良反应发生率观察组(9.4%)与对照组(3.1%)无差异(P>0.05)。结论:腹腔镜子宫切除术应用瑞芬太尼联合丙泊酚麻醉,可显著改善患者血流动力学指标、应激水平,降低患者疼痛介质水平和VAS评分,且不增加不良反应。

Objective:To investigate the analgesic effect of remifentanil combined with propofol used in laparoscopic hysterectomy of patients,and to study its influence on the hemodynamics and stress indexes of the patients.Methods:128patients who wanted laparoscopic hysterectomy were selected and were randomly divided into observation group and control group(64cases in each group)from January 2021to December 2023.Laparoscopic hysterectomy was performed in both groups.The patients in the control group were given sufentanil combined with propofol for anesthesia induction,and then pumped continuously for analgesic maintenance during laparoscopic hysterectomy.The patients in the observation group were given remifentanil combined with propofol for anesthesia induction,and then pumped continuously for analgesic maintenance during laparoscopic hysterectomy.The values of hemodynamic indexes,stress indexes and pain indexes,the visual analogue score(VAS)and the adverse reactions rate of the patients were compared between the two groups.Results:The values of heart rate and mean arterial pressure of the patients in the observation group after anesthesia induction,at tracheal intubation,at the beginning of the operation and immediately after the operation were significantly lower than those of the patients in the control group.The levels of epinephrine,cortisol,serotonin and neuropeptide of the patients in the two groups immediately after operation were significantly lower than those before operation,and which(60.26±5.41pg/ml,84.22±5.03ng/ml,90.24±9.31ng/L and 121.69±13.47μg/L)of the patients in the observation group were lower significantly than those(69.96±5.15pg/ml,92.15±6.39ng/ml,139.64±12.13ng/L and 160.55±16.36μg/L)of the patients in the control group.The pain score of the patients in the two groups immediately after operation were significantly lower than that before operation,and which(2.95±0.21 points)of the patients in the observation group was significantly lower than that(3.37±0.32points)of the patients in the control group(all P<0.05).There was no significant difference in the incidence of adverse reactions(9.4%vs.3.1%)of the patients between the two groups(P>0.05).Conclusion:Remifentanil combined with propofol used in aparoscopic hysterectomy for anesthesia can significantly improve the hemodynamic indexes and stress level,can reduce the pain mediator level and 371.9 VAS score of the patients,and without increasing the adverse reactions.