氯胺酮复合瑞芬太尼对腹腔镜子宫肌瘤剔除术患者血流动力学稳定性及术后并发症的影响

目的探析腹腔镜子宫肌瘤剔除术患者经氯胺酮复合瑞芬太尼后对术后并发症与血流动力学稳定性的影响。方法选取2016年5月至2018年5月北京市昌平区中西医结合医院妇科行腹腔镜子宫肌瘤剔除术的86例患者作为研究对象。对这86例患者的临床资料进行回顾性分析,掌握所选对象的麻醉与诊疗情况。根据不同麻醉方式分设为观察组(n=43)与对照组(n=43)。其中,行瑞芬太尼复合丙泊酚常规麻醉诱导对照组患者,在对照组的基础上,行小剂量氯胺酮维持麻醉诱导观察组患者。观察不同时间点两组患者血浆皮质醇浓度变化和血流动力学指标情况,以及术后疼痛,呼吸恢复时间、苏醒时间与拔管时间等手术指标,观察不良反应。结果对照组与观察组患者平均动脉压、心率等指标在麻醉前、气腹前、气腹后及手术结束时等时间点的变化情况比较,差异无统计学意义(P>0.05);对照组患者术后24小时平均动脉压与心率均高于观察组,差异具有统计学意义(P<0.05);对照组与观察组的血浆皮质醇浓度在气腹前、麻醉前等时间点的变化情况比较,差异无统计学意义(P>0.05);对照组血浆皮质醇浓度在气腹后、手术结束时和术后24小时时间点的变化情况均高于研究组,差异具有统计学意义(P<0.05);对照组和观察组的呼吸恢复时间、苏醒时间及拔管时间相比,差异无统计学意义(P>0.05);对照组术后VAS评分显著高于观察组,差异具有统计学意义(P<0.05);对照组患者苏醒期躁动率为25.6%,高于观察组的9.3%,差异具有统计学意义(P<0.05)。结论对行腹腔镜子宫肌瘤剔除术患者予以小剂量氯胺酮,能将术后痛觉过敏情况有效剔除,使患者术后血流动力学稳定性提升,术后并发症降低,应激水平下降。

Effect of ketamine combined with remifentanil on hemodynamic stability and postoperative complications in patients undergoing laparoscopic myomectomy

Objective To explore the effect of ketamine combined with remifentanil on the postoperative complications and hemodynamic stability in patients undergoing laparoscopic myomectomy. Methods The clinical data of 86 patients who underwent laparoscopic myomectomy in Changping District Hospital of Traditional Chinese and Western Medicine from May 2016 to May 2018 were collected and retrospectively analyzed. According to different anesthesia methods, they were divided into control group(n=43) and observation group(n=43). Among them, patients in the control group received remifentanil combined with propofol routine anesthesia induction, and patients in the observation group received low-dose ketamine maintenance anesthesia induction on the basis of the control group. The changes in plasma cortisol concentration and hemodynamic parameters at different time points, as well as postoperative pain, respiratory recovery time, recovery time and extubation time, and adverse reactions were observed in the two groups. Results There was no statistically significant difference in mean arterial pressure and heart rate between the two groups before anesthesia, before pneumoperitoneum, after pneumoperitoneum and at the end of operation(P>0.05). The average arterial pressure and heart rate in the control group were higher than those in the observation group 24 hours after operation(P<0.05). There was no significant difference in the changes of plasma cortisol concentration between the control group and the observation group before pneumoperitoneum and anesthesia(P>0.05). The changes of plasma cortisol concentration in the control group after pneumoperitoneum, at the end of operation and at 24 hours after operation were higher than those in the observation group, with statistically significant differences(P<0.05). There was no significant difference in respiratory recovery time, recovery time and extubation time between the control group and the observation group(P>0.05);the VAS score of the control group was significantly higher than that of the observation group(P<0.05);the restlessness rate of the control group(25.6%) was higher than that of the observation group(9.3%), with statistically significant differences(P<0.05). Conclusions Laparoscopic hysteromyomectomy with low-dose ketamine can effectively eliminate the postoperative hyperalgesia, improve the hemodynamic stability, reduce the complications and stress level of patients after laparoscopic hysteromyomectomy.