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

目的 分析靶控输注瑞芬太尼和舒芬太尼在腹腔镜子宫肌瘤剥除术中的临床应用,为腹腔镜子宫肌瘤剥除术时患者的麻醉提供参考.方法 将52例行腹腔镜子宫肌瘤剥除手术的患者随机分为观察组和对照组,观察组用靶控输注舒芬太尼.对照组靶控输注瑞芬太尼,当两者达到有效血药浓度时,均给予丙泊酚.观察手术期间患者的血压和心率变化情况,手术后患者的睁眼时间、拔管时间和术后的不良反应.结果 两组患者在麻醉诱导气管插管时血压波动和心率变化均有显著性差异(t值分别为5.72、4.42,均P<0.05),而两组在麻醉诱导前、拔出导管时血压波动和心率变化均无显著性差异(t值分别为1.04、-1.64、0.42、-1.59,均P<0.05),观察组患者的睁眼时间、拔管时间均显著高于对照组(t值分别为5.74、4.89,均P<0.05),而术后恶心呕吐、眼疼发生率均显著低于对照组(χ2值分别为7.31、5.532,均P<0.05).结论 妇科腹腔镜下子宫肌瘤剥除手术麻醉时候使用靶控输注舒芬太尼复合丙泊酚,在插管和拔管过程中血压和心率变化较瑞芬太尼小,对心率的抑制作用小,能过产生持续的,稳定的手术后镇痛作用,不需要使用其他镇痛药物,并且手术后的不良反应较小,但是对于需要手术后立刻清醒的病人建议在手术结束之前15分钟左右停止用药.

Target controlled infusion of sufentanil and remifentanil in laparoscopic uterine fibroids cystectomy in clinical research

Objective To analyze the clinical application of target-controlled infusion of remifentanil and sufentanil in laparoscopic uterine fibroids cystectomy so as to provide reference for anesthesia for patients undergoing laparoscopic uterine fibroids cystectomy.Methods Fifty-two patients undergoing laparoscopic uterine fibroids cystectomy were randomly divided into observation group and control group.The observation group was given target controlled infusion of sufentanil, and the control group was given target controlled infusion of remifentanil.When they reached effective blood concentration, propofol was given for both groups.Blood pressure and heart rate changes during surgery, patient's eye opening after surgery, extubation time and side effects were observed in two groups.Results Two groups were significantly different in fluctuation of blood pressure and heart rate in tracheal intubation during induction of anesthesia (t value was 5.72 and 4.42, respectively, both P<0.05), while they were not significantly different before anesthesia induction and pulling out catheter (t value was 1.04, -1.64, 0.42 and -1.59, respectively, all P>0.05).In the observation group patient' s eye opening time and extubation time were significantly longer than those in the control group (t value was 5.74 and 4.89, respectively, both P<0.05), but the incidences of nausea and vomiting, and eye pain were significantly lower than the control group after surgery (χ2 value was 7.31 and 5.532, respectively, both P <0.05 ) .Conclusion Target controlled infusion of sufentanil combined with propofol in anesthesia for laparoscopic uterine fibroids cystectomy causes slighter changes of blood pressure and heart rate in intubation and extubation process compared to remifentanil, and it has mild inhibition on heart rate and produce continuous and stable analgesia effect without use of other pain-killer.The adverse reactions are mild.For patients who need to wake up immediately after surgery, medication should be terminated 15 minutes before end of surgery.