胃癌手术患者采用瑞芬太尼全麻对心血管应激反应及相关应激指标的影响

目的研究在胃癌手术过程中，瑞芬太尼全麻对胃癌手术患者皮质醇及儿茶酚胺的影响。方法选择70例胃癌根治术患者，分成两组，每组35例，研究组诱导期注射瑞芬太尼，手术过程中持续泵注瑞芬太尼；对照组诱导期静注芬太尼，手术过程中根据麻醉深度的状况给予芬太尼。在记录麻醉中平均动脉压（MBP）、心率（HR）变化情况的同时，测量皮质醇（Cor）、肾上腺素（E）及去甲肾上腺素（NE）浓度，同时还记录插管呛咳及拔管时躁动例数。结果研究组的MBP、HR、Cor、E在麻醉诱导后均低于对照组，差异有统计学意义（P〈0．05）；研究组插管时呛咳例数及拔管时躁动例数均明显少于对照组，差异有统计学意义（P〈0．05）。结论在胃癌手术过程中，在减轻麻醉及手术对患者引起的应激反应方面，瑞芬太尼的作用效果很明显，与芬太尼相比效果更好。

Influence of Remifentanil anesthesia on cardiovascular stress response and stress indicators in patients with gastric cancer surgery

Objective To study the influence of Remifentanil anesthesia on cortisol and catecholamines in patients with gastric cancer surgery. Methods 70 cases of patients with gastric cancer surgery were selected and divided into two groups, each group with 35 cases, the study group was injected with Remifentanil in induction period, and continuous infusion of Remifentanil during surgery; control group was given intravenous Fentanyl in induction period, and given Fentanyl according to anesthesia depth situation during surgery. Then the mean arterial blood pressure （MBP）, changes in heart rate （HR） were recorded, at the same time, cortisol （Cor）, epinephrine （E） and norepinephrine （NE） were detected, choke cough cases and restlessness cases during intubation and extubation number were recorded. Resuits MBP, HR, Cor, E indicators of the research group were lower than those of the control group after anesthesia, the differences were statistically significant （P 〈 0.05）; the cough and restlessness number of patients in intubation and extubation were less than control group, the difference was statistically significant （P 〈 0.05）. Conclusion In gastric cancer surgery, the effect of Remifentanil in alleviating the stress response caused by surgery is obvious, and it is better compared with Fentanyl.