舒芬太尼与瑞芬太尼各自复合丙泊酚静脉麻醉在腹腔镜胆囊切除术的效果比较

目的:比较腹腔镜胆囊切除术(LC)中采用舒芬太尼与瑞芬太尼各自复合丙泊酚静脉麻醉复合丙泊酚静脉麻醉的应用效果。方法:纳入2017年3月―2018年3月行LC的患者90例,随机均分为两组,分别行舒芬太尼复合丙泊酚麻醉(舒芬太尼组)与瑞芬太尼复合丙泊酚麻醉(瑞芬太尼组),比较两组麻醉各时间段的血流动力学指标与血清应激指标、自主呼吸恢复时间、睁眼时间和拔管时间、术后视觉模拟(VAS)评分、术前与术后的简易精神状态量表(MMSE)评分以及麻醉复苏期不良反应情况。结果:与瑞芬太尼组比较,舒芬太尼组在麻醉诱导气管插管即刻、CO_2气腹后5min、拔管即刻的心率与平均动脉压、血清皮质醇与和去甲肾上腺素水平均明显降低(均P0.05);自主呼吸恢复时间、睁眼时间和拔管时间均明显延长(均P0.05);术后2、6、12h的VAS评分均明显降低(均P0.05);术后1d的MMSE评分明显升高(P0.05);总不良反应发生率明显降低(P0.05)。结论:相比瑞芬太尼复合丙泊酚麻醉,舒芬太尼复合丙泊酚静脉麻醉用于LC更有利于维持患者血流动力学稳定,应激反应更小,患者术后痛觉感受更轻,认知功能恢复更快,不良反应少。

Comparison of effects of sufentanil and remifentanil respectively combined with propofol for intravenous anesthesis in laparoscopic cholecystectomy

Objective: To compare the effects of sufentanil and remifentanil respectively combined with propofol for intravenous anesthesia in laparoscopic cholecystectomy (LC). Methods: Ninety patients undergoing LC from March 2017 to March 2018 were enrolled, equally randomized into two groups, and received intravenous anesthesia with sufentanil and propofol (sufentanil group) or remifentanil and propofol (remifentanil group). The hemodynamic parameters and serum stress indicators at predefined time points during anesthesia, times to recovery of spontaneous breathing, eye opening and extubation, scores of postoperative visual analogue scale (VAS), and pre- and postoperative scores of mini-mental state examination (MMSE) as well as incidence of adverse reactions were compared between the two groups. Results: In sufentanil group compared with remifentanil group, the heart rate and mean arterial pressure as well as serum levels of cortisol and norepinephrine were significantly decreased at the moment immediately after tracheal intubation and anesthesia induction, 5 min after CO2 pneumoperitoneum, and the moment immediately after tube removal (all P<0.05); the times to recovery of spontaneous breathing, eye opening and extubation were all significantly prolonged (all P<0.05); the VAS scores were significantly decreased at 2, 6 and 12 h after operation (all P<0.05); the MMSE score on the first postoperative day was significantly increased (P<0.05); the overall incidence of adverse reactions was significantly reduced (P<0.05). Conclusion: Compared to anesthesia using remifentanil combined with propofol, using sufentanil combined with propofol for LC is more helpful in maintaining the hemodynamic stability, weakening stress responses, lessening the severity of postoperative pain, quickening the recovery of cognitive function, and reducing the adverse reactions.