丙泊酚联合瑞芬太尼对腹腔镜胆囊切除术患者血流动力学的影响

Effect of propofol combined with remifentanil on hemodynamics in patients undergoing laparoscopic cholecystectomy

目的探讨丙泊酚联合瑞芬太尼对腹腔镜胆囊切除术(LC)患者血流动力学的影响。方法选取2019年6月至2021年6月于宜春市人民医院行LC的80例患者作为观察对象,按照随机数字表法分为对照组与观察组,每组40例。对照组行芬太尼复合丙泊酚麻醉方案,观察组行瑞芬太尼复合丙泊酚麻醉方案。比较两组血流动力学指标、应激反应指标、麻醉后恢复情况、意识状态、苏醒期躁动情况、不良反应发生情况。结果麻醉诱导前(T0)时,两组收缩压、舒张压均高于气管导管插管时(T1)、手术结束时(T2),对照组心率快于T1、T2,观察组心率高于T1,且T1时,两组收缩压、舒张压均低于T2,心率均慢于T2,差异有统计学意义(P<0.05);观察组T1与T2心率比较差异无统计学意义。T0时,两组收缩压、舒张压、心率比较差异无统计学意义;T1、T2时,观察组收缩压、舒张压均高于对照组,心率均快于对照组,差异有统计学意义(P<0.05)。T0时,两组皮质醇、去甲肾上腺素(NE)水平均低于T1、T2,且T1时,两组皮质醇、NE水平均高于T2,差异有统计学意义(P<0.05);T0时,两组皮质醇、NE水平比较差异无统计学意义;T1、T2时,观察组皮质醇、NE水平均低于对照组,差异有统计学意义(P<0.05)。观察组清醒时间、拔出气管导管时间、自主呼吸恢复时间均短于对照组,差异有统计学意义(P<0.05)。拔管后10 min,观察组观察者警觉镇静量表(OAAS)评分高于对照组,差异有统计学意义(P<0.05);拔管后60、240 min,两组OAAS评分均高于前一时间点,且观察组高于对照组,差异有统计学意义(P<0.05)。苏醒时,观察组Rasmay镇静评分高于对照组,差异有统计学意义(P<0.05);苏醒后30、120min,两组Rasmay镇静评分均高于前一时间点,且观察组高于对照组,差异有统计学意义(P<0.05)。结论瑞芬太尼复合丙泊酚麻醉方案可减轻LC患者的应激反应,稳定血流动力学,且有利于患者术后清醒与意识、呼吸的恢复,减少苏醒期躁动不良反应较少。

Objective To investigate the effect of propofol combined with remifentanil on hemodynamics in patients undergoing laparoscopic cholecystectomy(LC).Methods 80 patients who underwent LC in Yichun People's Hospital from June 2019 to June 2021 were selected as the ob-servation subjects,they were divided into the control group and the observation group according to the random number table method,with 40 cases in each group.The control group was treated with fentanyl combined with propofol anesthesia,and the observation group was treated with remifent-anil combined with propofol anesthesia.The hemodynamic indexes,stress response indexes,recovery after anesthesia,consciousness state,emer-gence agitation and adverse reactions were compared between the two groups.Results Before anesthesia induction(T0),the systolic blood pressure and diastolic blood pressure of the two groups were higher than those at the time of tracheal intubation(T1)and at the end of operation(T2),the heart rate in the control group was faster than that at T1 and T2,and the heart rate in the observation group was higher than that at T1.At T1,the systolic blood pressure and diastolic blood pressure of the two groups were lower than those at T2,and the heart rate was slower than that at T2,the differenc-es were statistically significant(P<0.05);there was no significant difference in heart rate between T1 and T2 in the observation group.At T0,there was no significant difference in systolic blood pressure,diastolic blood pressure and heart rate between the two groups;at T1 and T2,the systolic blood pressure and diastolic blood pressure in the observation group were higher than those in the control group,and the heart rate was faster than that in the control group,the differences were statistically significant(P<0.05).At T0,the levels of cortisol and norepinephrine(NE)of the two groups were lower than those at T1 and T2,and at T1,the levels of cortisol and NE of the two groups were higher than those at T2,the differences were statistically significant(P<0.05);at T0,there were no significant difference in cortisol and NE levels between the two groups;at T1 and T2,the levels of cortisol and NE in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The awake time,extubation time and spontaneous breathing recovery time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).At 10 min after extubation,the observer assessment of sedation(OAAS)score in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05);at 60 and 240 min after ex-tubation,the OAAS scores of the two groups were higher than those at the previous time point,and the observation group was higher than the control group,the differences were statistically significant(P<0.05).When awake,the Rasmay sedation score in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05);at 30 and 120 min after awakening,the Rasmay sedation scores of the two groups were higher than those at the previous time point,and the observation group was higher than the control group,the differences were statis-tically significant(P<0.05).Conclusion Remifentanil combined with propofol anesthesia can reduce the stress response of LC patients,stabilize hemodynamics,and is conducive to the recovery of patients'consciousness,consciousness and respiration after operation,and reduce the adverse re-actions of restlessness during recovery period.