靶控输注舒芬太尼和瑞芬太尼在妇科腹腔镜手术麻醉中的应用效果比较
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摘要
目的探讨靶控输注舒芬太尼和瑞芬太尼在妇科腹腔镜手术麻醉中的应用效果。方法选取我院于2016年3月～2017年10月收治的80例行妇科腹腔镜手术患者,将其按照靶控输注药物不同分为两组,每组40例。对照组予以靶控输注瑞芬太尼,研究组予以靶控输注舒芬太尼。比较两组患者麻醉前(t0)、诱导后3 min(t1)、插管时(t2)、切皮时(t3)、腹腔镜探查时(t4)、拔管时(t5)时的血流动力学指标;术后睁眼时间、气管插管拔管时间、首次诉求镇痛药时间;警觉-镇静(OAAS)评分、视觉模拟评分(VAS)。结果两组患者t1、t5时的HR、SBP、DBP水平均与t0时比较,差异均有统计学意义(P<0.05),研究组t1、t5时的HR、SBP、DBP水平与对照组比较,差异有统计学意义(P<0.05)。研究组的术后睁眼时间、气管插管拔管时间及首次诉求镇痛药时间均显著长于对照组(P<0.05)。研究组在复苏室停留30 min内的OAAS最高分、离开复苏室前的VAS评分均显著低于对照组(P<0.05)。两组在复苏室停留30 min后OAAS最高分比较,差异无统计学意义(P>0.05)。结论妇科腹腔镜手术麻醉采用靶控输注瑞芬太尼和舒芬太尼,血流动力学均较平稳,但瑞芬太尼相较于舒芬太尼恢复快,但术后疼痛程度较重。
Objective To investigate the application effect of target-controlled infusion of Sufentanil and Remifentanil in gynecological laparoscopic surgery anesthesia. Methods Eighty patients given gynecologic laparoscopic surgery treated in our hospital from March 2016 to October 2017 were selected and they were divided into the two groups according to different target-controlled infusion drugs, there were 40 cases in each group. The control group was given target-controlled infusion of Remifentanil while the study group was given target-controlled infusion of Sufentanil. The hemodynamic index before anesthesia(t0), 3 min after induction(t1), tracheal intubation(t2), skin incision(t3), laparoscopic probing(t4), and extubation(t5); postoperative awakening time, tracheal intubation/extubation time, time of appeal for analgesics for the first time; the observer assessment of alertness/sedation scale(OAAS) score, and visual analogue scale(VAS) score were compared in patients between the two groups. Results The level of heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) at t1 and t5 were significantly different from those at t0 in patients of the two groups(P<0.05). The level of HR, SBP and DBP in the study group were significantly different from those in the control group at t1 and t5(P <0.05). The time of postoperative awakening, tracheal intubation/extubation time, time of appeal for analgesics for the first time in the study group were obviously longer than those in the control group(P<0.05). In the study group, the OAAS maximal score within 30 min of staying at resuscitation room and VAS score before leaving resuscitation room were both lower compared with those in the control group(P<0.05). There was no significant difference in the maximal scores of OAAS between the two groups staying at the resuscitation room for over 30 min(P>0.05). Conclusion Hemodynamics of target-controlled infusion of Sufentanil and Remifentanil applied in gynecological laparoscopic surgery anesthesia are relatively stable, and recovery by Remifentanil is sooner than that by Sufentanil, but postoperative pain is severe.
Objective To investigate the application effect of target-controlled infusion of Sufentanil and Remifentanil in gynecological laparoscopic surgery anesthesia. Methods Eighty patients given gynecologic laparoscopic surgery treated in our hospital from March 2016 to October 2017 were selected and they were divided into the two groups according to different target-controlled infusion drugs, there were 40 cases in each group. The control group was given target-controlled infusion of Remifentanil while the study group was given target-controlled infusion of Sufentanil. The hemodynamic index before anesthesia(t0), 3 min after induction(t1), tracheal intubation(t2), skin incision(t3), laparoscopic probing(t4), and extubation(t5); postoperative awakening time, tracheal intubation/extubation time, time of appeal for analgesics for the first time; the observer assessment of alertness/sedation scale(OAAS) score, and visual analogue scale(VAS) score were compared in patients between the two groups. Results The level of heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) at t1 and t5 were significantly different from those at t0 in patients of the two groups(P<0.05). The level of HR, SBP and DBP in the study group were significantly different from those in the control group at t1 and t5(P <0.05). The time of postoperative awakening, tracheal intubation/extubation time, time of appeal for analgesics for the first time in the study group were obviously longer than those in the control group(P<0.05). In the study group, the OAAS maximal score within 30 min of staying at resuscitation room and VAS score before leaving resuscitation room were both lower compared with those in the control group(P<0.05). There was no significant difference in the maximal scores of OAAS between the two groups staying at the resuscitation room for over 30 min(P>0.05). Conclusion Hemodynamics of target-controlled infusion of Sufentanil and Remifentanil applied in gynecological laparoscopic surgery anesthesia are relatively stable, and recovery by Remifentanil is sooner than that by Sufentanil, but postoperative pain is severe.
引文
[1]莫明表,冯才杰,符坎托.依托咪酯靶控输注复合瑞芬太尼用于妇科腹腔镜手术麻醉的临床效果[J].吉林医学,2016,37(3):645-646.
[2]徐延德.瑞芬太尼和芬太尼复合异丙酚用于妇科短时间手术麻醉效果[J].包头医学院学报,2016,32(6):77-78.
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[4]韩甫,葛俊芳,张雪花.靶控输注舒芬太尼与瑞芬太尼在腹腔镜子宫肌瘤剥除术中的临床应用[J].中国妇幼健康研究,2016,27(10):1281-1283.
[5]何永军.靶控输注舒芬太尼与瑞芬太尼在妇科腹腔镜手术中麻醉效果观察[J].浙江创伤外科,2016,21(4):791-793.
[6]陈玉,张文强,邱小凤.宫腔镜手术中应用舒芬太尼与瑞芬太尼复合丙泊酚麻醉的效果对比[J].中外医疗,2016,35(20):121-123.
[7]范成云.舒芬太尼与瑞芬太尼靶控输注在妇科腹腔镜手术麻醉中的应用实效性探究[J].中国实用医刊,2016,43(12):85-88.
[8]郭宗锋.瑞芬太尼和舒芬太尼用于妇科腹腔镜手术围拔管期血流动力学的比较[J].河北联合大学学报(医学版),2016,18(2):104-106.
[9]沈永波.瑞芬太尼在妇科手术麻醉中的应用[J].浙江创伤外科,2016,21(2):382-384.
[10]宋斌,蒋晧宇,闫鑫,等.靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床研究[J].新疆医科大学学报,2017,40(6):751-754.
[11]陈清娟,陈健,陈宏才.舒芬太尼与瑞芬太尼联合麻醉在腹腔镜子宫切除手术中的应用[J].中国现代医生,2018,56(1):111-114.
[12]周子超.靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床研究[J].检验医学与临床,2017,14(A1):282-283.
[13]刘东海.靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的效果比较[J].现代中西医结合杂志,2016,25(20):2264-2265.
[14]高兴蓉,罗林丽,罗东,等.舒芬太尼持续泵注在老年患者妇科开腹手术麻醉中的应用[J].西部医学,2016,28(10):1420-1422.
[2]徐延德.瑞芬太尼和芬太尼复合异丙酚用于妇科短时间手术麻醉效果[J].包头医学院学报,2016,32(6):77-78.
[3]赵通.妇科腹腔镜手术采用舒芬太尼和瑞芬太尼靶控输注静脉麻醉的临床效果研究[J].中外医疗,2017,36(10):15-18.
[4]韩甫,葛俊芳,张雪花.靶控输注舒芬太尼与瑞芬太尼在腹腔镜子宫肌瘤剥除术中的临床应用[J].中国妇幼健康研究,2016,27(10):1281-1283.
[5]何永军.靶控输注舒芬太尼与瑞芬太尼在妇科腹腔镜手术中麻醉效果观察[J].浙江创伤外科,2016,21(4):791-793.
[6]陈玉,张文强,邱小凤.宫腔镜手术中应用舒芬太尼与瑞芬太尼复合丙泊酚麻醉的效果对比[J].中外医疗,2016,35(20):121-123.
[7]范成云.舒芬太尼与瑞芬太尼靶控输注在妇科腹腔镜手术麻醉中的应用实效性探究[J].中国实用医刊,2016,43(12):85-88.
[8]郭宗锋.瑞芬太尼和舒芬太尼用于妇科腹腔镜手术围拔管期血流动力学的比较[J].河北联合大学学报(医学版),2016,18(2):104-106.
[9]沈永波.瑞芬太尼在妇科手术麻醉中的应用[J].浙江创伤外科,2016,21(2):382-384.
[10]宋斌,蒋晧宇,闫鑫,等.靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床研究[J].新疆医科大学学报,2017,40(6):751-754.
[11]陈清娟,陈健,陈宏才.舒芬太尼与瑞芬太尼联合麻醉在腹腔镜子宫切除手术中的应用[J].中国现代医生,2018,56(1):111-114.
[12]周子超.靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床研究[J].检验医学与临床,2017,14(A1):282-283.
[13]刘东海.靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的效果比较[J].现代中西医结合杂志,2016,25(20):2264-2265.
[14]高兴蓉,罗林丽,罗东,等.舒芬太尼持续泵注在老年患者妇科开腹手术麻醉中的应用[J].西部医学,2016,28(10):1420-1422.