舒芬太尼与芬太尼对妇科腹腔镜手术患者应激反应和认知功能影响的比较  

Comparison of the Effect of Sufentanil and Fentanyl on the Stress Response and Cognitive Function of Patients with Gynecologic Laparoscopic Surgery

作　　者：蒋玲[1] 盛思玉 徐凯[1] 王亚祥[1] 

机构地区：[1]淮安市淮阴医院麻醉科,江苏淮安223300

出　　处：《医学综述》2016年第16期3267-3270,共4页Medical Recapitulate

摘　　要：目的比较舒芬太尼与芬太尼对妇科腹腔镜手术患者应激反应和认知功能的影响。方法选取2012年1月到2015年1月淮安市淮阴医院择期进行妇科腹腔镜手术患者52例作为研究对象,按照随机数字表法分为观察组和对照组,各26例。在静脉注射咪达唑仑后,观察组注射舒芬太尼0.6μg/kg,对照组注射芬太尼3μg/kg,其他手术操作均相同。于麻醉诱导前5 min(T0)、气管插管后即刻(T1)、气腹完成后5 min(T2)、手术完成时(T3)、气管拔管时(T4)5个时间点检测肾上腺素、去甲肾上腺素水平及心率、平均动脉压。同时记录患者术中出血量、手术时间、气腹时间、苏醒时间、拔管时间以及丙泊酚用量;于术前1 d、术后1 d使用简易精神状态评定量表(MMSE)评估患者认知功能。此外,比较患者术后不良反应发生情况。结果两组患者出血量、手术时间、气腹时间、苏醒时间、拔管时间差异无统计学意义(P>0.05),但观察组丙泊酚用量显著少于对照组[(511±103)mg比(763±131)mg,P<0.05]。观察组T1、T2、T3、T4去甲肾上腺素、肾上腺素较T0降低,呈先降低后升高趋势。对照组T1、T2、T3、T4去甲肾上腺素、肾上腺素较T0升高,呈先升高后降低趋势。观察组T1、T2、T3、T4平均动脉压、心率较T0呈先下降再上升再降低再升高的波动趋势。对照组T1、T2、T3、T4平均动脉压、心率较T0呈先上升再降低再升高趋势。两组在组间、不同时点间、组间·不同时点间交互效应比较差异均有统计学意义(P<0.05)。术后观察组患者MMSE评分显著低于对照组[(24.5±1.2)分比(26.2±1.0)分,P<0.05];同时,观察组认知障碍发生率、不良反应发生率显著低于对照组[11.5%(3/26)比34.6%(9/26),11.5%(3/26)比34.6%(9/26),P<0.05]。结论与芬太尼比较,舒芬太尼可明显减少丙泊酚用量,对患者应激反应影响小,术后认知障碍发生率也较低,不良反应少,安全可靠。Objective To compare the effects of sufentanil and fentanyl on the stress response and cognitive function of patients with gynecologic laparoscopic surgery. Methods Total of 52 cases of elective gynecological laparoscopy surgery in Huai＇an Huaiyin Hospital from Jan. 2012 to Jan. 2015 were included in the study and divided into an observation group and a control group according to the random number table method, 26 cases each. The observation group was given sufentani injection by 0. 6 μg/kg, and the control group was given fentanyl by 3 μg/kg. The epinephrine,norepinephrine,and heart rate,mean arterial pressure at 5 min prior to the induction of anesthesia（ T0 ） ,immediately after intubation （ T1 ）, 5 minafter pneumoperitoneum （ T2 ）, operation completion （T3 ）, extubation （ T4 ） were recorded, and the patient blood loss,operative time,pneumoperiteneum time, recovery time, extubation time and the dose of propofol were recorded as well; mini-mental status scale （MME） score was used to assess the cognitive function of the patient at preoperative 1 d and postperative 1 d. In addition ,the postop- erative adverse reactions or complications were observed and compared. Results Blood loss, operative time, pneu- moperiteneum time, recovery time, extubatian time of the two group were not statistically significantly different （ P 〉 0. 05） ,but propofol of the observation group was significantly lower than the control group[ （ 511 ± 103 ） mg vs （763 ±131 ） mg,P 〈0. 05 ]. N0repinephrine,epinephrine T1 ,T2 ,T3 ,T4 of observation group decreased than To, showed first decreased then increased trend. Norepinephrine,epinephrine T1 ,T2 ,T3 ,T4 of control group increased than To, showed first increasd then decreased. Mean arterial pressure,heart rate,T1 ,T2,T3,T4 of observation group first decreased then increased,then decreased and then increased. Mean arterial pressure,heart rate,T1 ,T2 ,T3 ,T4 of control group first increasd then decreased and then increasd. The differences of the in

关 键 词：舒芬太尼 芬太尼 应激反应 认知功能 

分 类 号：R971[医药卫生—药品]