舒芬太尼与瑞芬太尼联合应用对乳腺癌根治术患者麻醉效果和应激反应的影响

目的:探讨舒芬太尼和瑞芬太尼联合应用对乳腺癌根治术患者麻醉效果及应激反应的影响。方法:选择2017年01月-2019年01月我院乳腺癌根治术患者80例，随机分为实验组（舒芬太尼和瑞芬太尼联合用药）、对照组（单用瑞芬太尼）两组，每组40例。观察两组患者在麻醉前0 min(T1)、气管插管前即刻(T2)、插管后1 min(T3)、拔管后1 min(T4)、拔管后5 min(T5)时的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SPO2)的变化，以及术后6 h(T6)、12 h(T7)、24 h(T8)时的VAS评分和拔管后10 min的躁动评分(RS)、警觉/镇静评分(OAA/S)；同时，观察T1、T3、T4、T6、T7、T8时去甲肾上腺素(NE)、肾上腺素(E)的水平。将两组患者的监测指标进行统计学比较。结果:两组患者在T2时HR、MAP水平均较T1时有所下降(P＜0.05)，在T3-T5时，实验组的HR、MAP水平显著低于对照组(P＜0.05)；两组患者的NE、E水平均在T3、T4时较T1时有所升高(P＜0.05)，且在T7、T8时均出现下降趋势(P＜0.05)，在T3、T4、T6、T7、T8这5个时间点，实验组的NE、E水平显著低于对照组(P＜0.05)；实验组的RS、OAA/S、VAS评分均显著低于对照组(P＜0.05)；各个时间点的SPO2在两组间未观察到显著差异(P＞0.05)。结论:与单用瑞芬太尼相比，舒芬太尼和瑞芬太尼联合应用能够更好地维持乳腺癌根治术患者的血流动力学稳定、减少围手术期应激反应并降低术后疼痛的程度。

Effects of sufentanil combined with remifentanil on the effect of anesthesia and stress response in patients undergoing radical mastectomy

Objective:To investigate the effect of combined use of sufentanil and remifentanil on perioperative stress response in patients undergoing radical mastectomy.Methods:Eighty cases of patients undergoing radical mastectomy were randomly divided into the experimental group (sufentanil and remifentanil combination) and the control group (remifentanil alone),with 40 cases in each group.The heart rate (HR),mean arterial pressure (MAP) and pulse oxygen saturation (SPO2) of patients in the two groups before anesthesia 0 min (T1),before endotracheal intubation (T2),1 min after intubation (T3),1 min after extubation (T4),and 5 min after extubation (T5) were recorded.VAS score at 6 h(T6),12 h(T7) and 24 h(T8) after extubation,agitation score (RS) and alertness/sedation score (OAA/S) were evaluated.Meanwhile,the levels of norepinephrine (NE) and epinephrine (E) at T1,T3,T4,T6,T7 and T8 were detected.Results:The levels of HR and MAP in the two groups were lower at T2 than at T1 (P＜0.05).At T3-T5,the levels of HR and MAP in the experimental group were significantly lower than those in the control group (P＜0.05).The levels of NE and E in both groups were higher at T3 and T4 than at T1 (P＜0.05),lower at T7 and T8 than at T1 (P＜0.05).At the time points of T3,T4,T6,T7 and T8,the levels of NE and E in the experimental group were significantly lower than those in the control group (P＜0.05).RS,OAA/S and VAS scores in the experimental group were significantly lower than those in the control group (P＜0.05).No significant difference was observed in SPO2 at each time point between the two groups (P＞0.05).Conclusion:The combined use of sufentanil and remifentanil can better reduce the perioperative stress response of patients undergoing radical mastectomy compared with the single use of remifentanil for anesthesia.