七氟醚与丙泊酚联合瑞芬太尼麻醉在腹腔镜胆囊切除术患者中的应用效果比较

Comparison of application effects of Sevoflurane and Propofol combined with Remifentanil anesthesia in patients undergoing laparoscopic cholecystectomy

目的:比较七氟醚与丙泊酚联合瑞芬太尼麻醉在腹腔镜胆囊切除术患者中的应用效果。方法:选取2020年2月至2023年2月该院收治的102例行腹腔镜胆囊切除术的胆囊结石患者进行前瞻性研究,按照随机数字表法将其分为研究组与对照组各51例。对照组采用丙泊酚联合瑞芬太尼麻醉,研究组采用七氟醚联合瑞芬太尼麻醉,比较不同时间[麻醉诱导前(T_(1))、插管后即刻(T_(2))、拔管后5 min(T_(3))]血流动力学指标、应激指标[肾上腺素(E)、β-内啡肽(β-EP)、皮质醇(Cor)]水平,拔管时间,意识恢复时间,以及麻醉不良反应发生率。结果:T_(2)~T_(3)时,两组心率、平均动脉压水平均呈先升高后降低的趋势,且研究组低于对照组,差异有统计学意义(P<0.05);术后24 h,两组E、β-EP、Cor水平均高于术前,但研究组低于对照组,差异有统计学意义(P<0.05);研究组拔管时间、意识恢复时间均短于对照组,差异有统计学意义(P<0.05);研究组麻醉不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:七氟醚联合瑞芬太尼麻醉应用于腹腔镜胆囊切除术患者可降低血流动力学指标水平、应激指标水平和麻醉不良反应发生率,缩短拔管时间和意识恢复时间,其效果优于丙泊酚联合瑞芬太尼麻醉。

Objective:To compare application effects of Sevoflurane and Propofol combined with Remifentanil anesthesia in patients undergoing laparoscopic cholecystectomy.Methods:A prospective study was conducted on 102 patients with cholecystolithiasis who underwent laparoscopic cholecystectomy in this hospital from February 2020 to February 2023.According to the random number table method,they were divided into study group and control group,51 cases in each group.The control group was anesthetized with Propofol combined with Remifentanil,while the study group was anesthetized with Sevoflurane combined with Remifentanil.The levels of hemodynamic indexes and stress indexes[epinephrine (E),β-endorphin (β-EP),cortisol (Cor)]at different time[before anesthesia induction (T_(1)),immediately after intubation (T_(2)),5 min after extubation (T_(3))],the extubation time,the consciousness recovery time,and the incidence of adverse reactions of anesthesia were compared.Results:At T_(2)-T_(3),the heart rate and mean arterial pressure levels of the two groups increased and then decreased,those in the study group were lower than those in the control group,and the differences were statistically significant (P<0.05).24 h after the surgery,the levels of E,β-EP and Cor in the two groups were higher than those before the surgery,but those in the study group were lower than those in the control group,and the differences were statistically significant (P<0.05).The extubation time and the consciousness recovery time of the study group were shorter than those of the control group,and the differences were statistically significant (P<0.05).Further,the incidence of anesthesia adverse reactions in the study group was lower than that in the control group,and the difference was statistically significant (P<0.05).Conclusions:Sevoflurane combined with Remifentanil anesthesia in the patients undergoing laparoscopic cholecystectomy can reduce the levels of hemodynamic indexes,the levels of stress indexes and the incidence of adverse reactions of anesthesia,and shorten the extubation time and the consciousness recovery time.Moreover,it is superior to Propofol combined with Remifentanil anesthesia.