七氟醚联合瑞芬太尼对腹腔镜子宫切除术患者血流动力学及应激反应的影响

Effects of sevoflurane combined with remifentanil on hemodynamics and stress response in patients undergoing laparoscopic hysterectomy

目的探讨七氟醚联合瑞芬太尼对腹腔镜子宫切除术患者血流动力学及应激反应的影响。方法选取2019年1月至2022年5月于上饶市妇幼保健院行腹腔镜子宫切除术的82例患者作为研究对象,根据随机抽签法分为对照组与观察组,每组41例。对照组给予丙泊酚联合舒芬太尼麻醉,观察组给予七氟醚联合瑞芬太尼麻醉,比较两组血流动力学变化、应激反应、麻醉不良反应发生情况及麻醉后恢复情况。结果气腹后10min,两组心率(HR)均慢于麻醉前,两组平均动脉压(MAP)及观察组血氧饱和度(SpO_(2))均高于麻醉前,对照组SpO_(2)低于麻醉前,且观察组HR慢于对照组,MAP低于对照组,SpO_(2)高于对照组,差异有统计学意义(P<0.05)。气腹后10min,两组皮质醇(COR)、去甲肾上腺素(NE)水平均高于麻醉前,但观察组低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为4.88%,低于对照组的19.51%,差异有统计学意义(P<0.05)。观察组苏醒时间、恢复自主呼吸时间、拔管时间均短于对照组,差异有统计学意义(P<0.05)。结论七氟醚联合瑞芬太尼维持腹腔镜子宫切除手术患者稳定的血流动力学变化,减轻应激反应,减少麻醉后不良反应,保证患者麻醉安全,恢复情况良好,值得临床优先选择。

Objective To investigate the effects of sevoflurane combined with remifentanil on hemodynamics and stress response in patients un-dergoing laparoscopic hysterectomy.Methods 82 patients who underwent laparoscopic hysterectomy in Shangrao Maternal and Child Health Hospi-tal from January 2019 to May 2022 were selected as the research subjects,they were divided into the control group and the observation group accord-ing to the random lottery method,with 41 cases in each group.The control group was given propofol combined with sufentanil,and the observation group was given sevoflurane combined with remifentanil,the hemodynamic changes,stress response,adverse reactions of anesthesia and recovery af-ter anesthesia were compared between the two groups.Results At 10 min after pneumoperitoneum,the heart rate(HR)of the two groups was slower than that before anesthesia,the mean arterial pressure(MAP)of the two groups and the pulse oxygen saturation(SpO_(2))in the observation group were higher than those before anesthesia,SpO_(2) in the control group was lower than that before anesthesia,HR in the observation group was slower than that in the control group,MAP was lower than that in the control group,and SpO_(2) was higher than that in the control group,the differences were statistical-ly significant(P<0.05).At 10 min after pneumoperitoneum,the levels of cortisol(COR)and norepinephrine(NE)of the two groups were higher than those before anesthesia,but the observation group was lower than the control group,the differences were statistically significant(P<0.05).The inci-dence of adverse reactions in the observation group was 4.88%,which was lower than 19.51%in the control group,and the difference was statistically significant(P<0.05).The recovery time,spontaneous breathing recovery time and extubation time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Sevoflurane combined with remifentanil can maintain sta-ble hemodynamic changes in patients undergoing laparoscopic hysterectomy,reduce stress response,reduce adverse reactions after anesthesia,ensure the safety of anesthesia and good recovery,which is worthy of clinical priority.