芬太尼药物联合应用对老年胆囊切除术患者围手术期应激反应及术后疼痛的影响

目的：观察芬太尼药物联合应用对老年胆囊切除术患者围手术期应激反应及术后疼痛的影响。方法：以2014年3月至2015年9月在我院接受腹部手术的老年患者为观察对象，并将其随机分为对照组和观察组，对照组给予瑞芬太尼诱导麻醉，观察组给予瑞芬太尼联合舒芬太尼进行诱导麻醉。比较两组患者围手术期血气、应激指标以及疼痛指标的变化。结果：瑞芬太尼组的平均动脉压(mean arterial pressure，MAP)、心率(heart rate，HR)在切皮后2 h、术后4 h和术后12 h较麻醉前波动较大，而联合用药组在术后12 h时恢复麻醉前水平；两组患者的血氧饱和度(SpO2)水平均较麻醉前无明显改变；瑞芬太尼组的血糖、皮质醇等指标在切皮后2 h、术后4 h和术后12 h时变化较联合用药组明显(P<0.05)；两组术后1 d时的VAS得分及5-HT水平无明显差别，术后3 d时，两组患者的VAS得分及5-HT水平均较术后1 d时降低，且观察组降低更明显(P<0.05)。结论：瑞芬太尼联合舒芬太尼诱导麻醉可减轻老年围手术期患者的应激反应，减轻患者的术后疼痛。

Effects of fentanyl combined with drugs on perioperative stress response and postoperative pain in elderly patients undergoing cholecystectomy

Objective: To observe the effect of combined application of fentanyl on stress response and postoperative pain in elderly patients undergoing cholecystectomy.Methods: Elderly patients with abdominal accepted surgery in our hospital from March 2014 to September 2015 were selected as the objects. According to the random number table, the patients were divided into control group and observation group. hTe control group received remifentanil anesthesia induction, the observation group were given remifentanil and sufentanil for induction of anesthesia. hTe changes of blood gas in perioperation, stress index and pain index were compared between the two groups. Results: Atfer 2 h skin incision, 4 h and 12 h atfer surgery, the level of mean arterial pressure (MAP), heart rate (HR) in remifentanil group changed more obvious compared with observation group, and observation group recovered 12 h atfer surgery; the level of SpO2 in the two groups had no difference before and atfer anesthesia; the level of blood glucose, cortisol index in remifentanil group changed more obvious than combined treatment group, the difference was statistically different (P<0.05); the VAS scores and level of 5-HT had no signiifcant difference between the two groups atfer 1 d. hTe VAS scores and level of 5-HT of the two groups atfer 3 d were lower than that of the 1 d, and the observation group decreased more signiifcantly (P<0.05).Conclusion: Remifentanil and sufentanil induced anesthesia can reduce the stress reaction of senile perioperative patients, which can reduce the patient’s postoperative pain.