舒芬太尼TCI麻醉对妇科腹腔镜手术围手术期应激反应的影响

目的探讨靶控输注舒芬太尼麻醉在妇科腹腔镜手术围手术期对患者应激反应的影响。方法选择择期全麻腹腔镜手术患者60例,采用单盲、随机、对照实验设计,分为舒芬太尼组和芬太尼组,每组30例,均采用靶控输注舒芬太尼或芬太尼复合丙泊酚全凭静脉麻醉。记录患者入室后基础值（T0）、插管后3min（T1）、气腹后10min（T2）、气腹后40min（T3）、解除气腹后20min（T4）的MAP、HR、PETCO2等指标,于相应时点采集静脉血3m1测定血清皮质醇（Cor）浓度及血糖（Glu）含量。结果两组间MAP、HR、Glu总体差异无统计学意义（P〉0.05）,Cor含量总体差异有统计学意义（P〈0.05）,舒芬太尼组含量较低;各时间点比较,术中两组MAP、HR均升高,但与T0比较差异无统计学意义（P〉0.05）,Cor、Glu含量均先升后降,与T0比较差异有统计学意义（P〈0.01）;各时间点间与组间交互效应,HR、MAP各时间点与组间不存在交互效应（P〉0.05）,Cor各时间点间与组间存在交互效应（P〈0.05）,舒芬太尼组中T1、T2、T3、T4时间点测得血清Cor含量均较芬太尼组低,Glu在术中各时间点间与组间存在交互效应（P〈0.05）,舒芬太尼组T1、T2、含量比芬太尼组低。结论舒芬太尼与芬太尼均有效地抑制妇科腹腔镜手术刺激所造成的应激反应,但舒芬太尼较芬太尼能更好地抑制妇科腹腔镜手术引起的Cor分泌,维持机体生理功能稳定。

Effect of TCI anesthesia with sufentanil on systemic stress response during gynecological laparoscopic operation

Objective To explore the effect of sufentanil by target-controlled infusion（TCI） on stress response during gynecological laparoscopic operation.Methods 60 patients undergoing selected gynecological laparoscopic with total intravenous anesthesia,using sufentanil or fentanyl combined with propofol by TCI,were divided into 2 groups at single blind and random：S group and F group.MAP,HR,PET CO2 of all patients were observed at entering operating room（T0）,at 3 minutes after tracheal intubation（T1）,at 10 minutes after pneumoperitoneum（T2）,at 40 minutes after pneumoperitoneum（T3） and at 20 minutes cease pneumoperitoneum（T4）.The concentrations of cortisol（Cor） and glucose（Glu） were measured at above time.Results There was no significant difference of MAP,HR,Glu between S group and F group,but Cor in S group was lower than that in F group,with significant difference（P0.05）.Compared with T0,MAP and HR increased but had no significant difference between two groups.Compared with T0,the concentrations of Cor and Glu increased first and then decreased in two groups（P0.01）.It showed a significant interactive effect in Cor and Glu（P0.05）.The concentration of Cor in S group was lower than that in F group at T1,T2,T3,T4.The concentration of Glu in S group was lower than that in F group at T1,T2.Conclusion Sufentanil and fentanyl through TCI can restrain stress response induced by gynecological laparoscopic operation,but sufentanil can restrain secreting of Cor induced by gynecological laparoscopic operation better than fentanyl in maintaining the balance of physiologic function.