舒芬太尼复合瑞芬太尼在胃癌根治术的应用及对血流动力学及应激水平的影响

Sufentanil combined with remifentanil in radical gastrectomy and its effect on hemodynamics and stress level

目的探讨舒芬太尼复合瑞芬太尼在胃癌根治术中的应用价值及对血流动力学及应激水平的影响。方法选取2016年11月至2019年4月间上海复旦大学附属闵行医院收治的行胃癌根治术的治疗的94例患者,根据使用麻醉药物不同进行分组。其中,行瑞芬太尼麻醉的46例患者纳入对照组,行舒芬太尼复合瑞芬太尼麻醉的48例患者纳入复合组。比较两组患者麻醉前、插管前、插管后1min、拔管后1min及拔管后5min的血流动力学及应激水平的变化和拔管10min后清醒镇静评分、躁动评分及术后6h、12h和24h的疼痛评分,并评估舒芬太尼复合瑞芬太尼在胃癌根治术中的临床价值。结果与麻醉前比较,两组患者插管前的HR(心率)和MAP(平均动脉压)水平下降,两组患者插管后1min、拔管后1min及拔管后5min的HR和对照组拔管后1min的MAP均升高且高于麻醉前水平,复合组拔管后1min的MAP升高仍低于麻醉前水平,差异均有统计学意义(均P <0. 05)。复合组患者的HR和MAP水平在插管后1min、拔管后1min及拔管后5min均低于对照组患者,差异均有统计学意义(均P <0. 05)。复合组患者各时间点的清醒镇静评分、躁动评分及疼痛评分均小于对照组患者,差异有统计学意义(P <0. 05)。两组患者的肾上腺素(E)和去甲肾上腺素(NE)水平插管后1min、拔管后1min及术后12h和术后24h均呈逐渐下降趋势,差异均有统计学意义(均P <0. 05)。且复合组插管后1min、拔管后1min及术后12h和术后24h的E和NE水平均低于对照组,差异均有统计学意义(均P <0. 05)。结论舒芬太尼复合瑞芬太尼能有效维持插管全麻手术患者的血流动力学稳定,降低应激水平,缓解术后疼痛。

Objective To investigate efficacy of sufentanil combined with remifentanil in radical gastrectomy and its effect on hemodynamics and stress level.Methods A total of 94 patients who underwent radical gastrectomy at Minhang Hospital Affiliated to Fudan University from November 2016 to April2019 were selected.According to anesthetics used,patients were assigned to different groups.Forty-eight patients who received sufentanil combined with remifentanil as combined anesthesia were included in the combination group.Forty-six patients who were given remifentanil anesthesia during radical gastrectomy were included in the control group.The changes in hemodynamics and stress levels before anesthesia,before intubation,at 1 min after intubation,1 min after extubation and 5 min after extubation were compared.Alertness/sedation(OAA/S)score and restlessness score at 10 min after the extubation and pain score at 6 h,12 h and 24 h after the surgery and the clinical value of sufentanil combined with remifentanil in radical gastrectomy were evaluated.Results Heart rate(HR)and mean arterial pressure(MAP)levels decreased after the anesthesia compared with before anesthesia in both groups.MAP increased at 1 min after intubation,1 min after extubation and 5 min after extubation(all P<0.05).HR and MAP levels were lower in the combination group than in the control group at 1 min after intubation,1 min after extubation and 5 min after extubation(all P<0.05).However,OAA/S score and restlessness score and pain score were lower at each time point in the combination group than in the control group(all P<0.05).In addition,the epinephrine(E)and norepinephrine(NE)levels decreased in both groups at 1 min after intubation,1 min after extubation,and 12 h and 24 h after the surgery(all P<0.05)with the combination group lower than the control group(all P<0.05).Conclusion Sufentanil combined with remifentanil can effectively maintain hemodynamic stability,reduce stress level and relieve postoperative pain in patients undergoing intubation under general anesthesia.