七氟烷或丙泊酚复合瑞芬太尼全麻对腹腔镜手术患者麻醉苏醒期的影响

Effect of sevoflurane or propofol combined with remifentanil anesthesia on the recovery period in laparoscopic surgery patients

目的观察比较七氟烷与丙泊酚复合瑞芬太尼对腹腔镜微创手术患者麻醉后恢复质量的影响,为临床制定更有效麻醉方案提供参考。方法选择本院78例气管插管全麻后行腹腔镜微创手术治疗的女性患者,随机数字表法予以分两组:C1组39例(七氟烷复合瑞芬太尼维持麻醉);C2组39例(丙泊酚复合瑞芬太尼维持麻醉)。记录且比较两组围手术期各时间点收缩压(SBP)、舒张压(DBP)、心率(HR),拔气管导管时呼吸频率、手术结束至拔气管导管时间、恶心呕吐评分、最大Ricker镇静躁动评分、疼痛数字评分(NRS)评分、咳嗽评分及恢复质量评分(Qo R-40评分)。结果两组患者的SBP、DBP、HR在各时间点上比较差异均无统计学意义(均P>0.05);两组患者拔管时呼吸频率差异无统计学意义(P>0.05);与C1组比较,C2组手术结束至拔管时间短[(5.60±2.20)min vs.(10.40±2.50)min,t=9.140,P=0.000],咳嗽评分、恶心呕吐评分、NRS评分均低(P<0.05);C2组最大Ricker镇静躁动评分低于C1组,差异有统计学意义(P<0.05);C2组Qo R-40评分明显低于C1组,差异有统计学意义(P<0.05)。结论丙泊酚复合瑞芬太尼与七氟烷复合瑞芬太尼在腹腔镜微创手术中,均具有稳定的麻醉效果,丙泊酚较七氟烷麻醉后恢复质量高,具有临床推广应用的价值。

Objective To observe the different recovery qualities in minimally invasive laparoscopic surgery patients under general anesthesia with sevoflurane or propofol combined with remifentanil. Methods 78 female patients underwent minimally invasive laparoscopic surgery were divided into 2 groups by random number table method with 39 patients in each group. Patients in group C1 were anesthetized with sevoflurane combined with remifentanil while patients in group C2 were under the anesthesia of propofol combined with remifentanil. Systolic blood pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR) at each time point were recorded during the operation and respiratory rate, extubation time, nausea score, maximum Ricker sedation agitation scale, NRS score, cough score and Qo R-40 quality of recovery score in recovery stage after surgery were also recorded and compared. Results Comparison of SBP, DBP and HR at each time point showed no significant difference between the 2 groups(P>0.05); Extubation time and cough score, nausea score, NRS score in group C2 were less than those in C1 group(P<0.05); the maximum Ricker sedation agitation score in group C1 was higher than that in C2(P<0.05); Qo R-40 quality of recovery score in group C2 were significant higher than those in C1(P<0.05). Conclusions Both propofol combined with remifentanil and sevoflurane combined with remifentanil could provide stable anesthesia for minimally invasive laparoscopic surgery. Patients under sevoflurane anesthesia showed high incidence of agitation at the end of operation. While the recovery quality of patients under propofol anesthesia in PACU and 24 hours after surgery were higher than those with sevoflurane anesthesia