七氟醚联合瑞芬太尼麻醉对腹腔镜下子宫肌瘤切除术病人应激反应及血流动力学的影响  

Effect of sevoflurane combined with remifentanil anesthesia on stress response and hemodynamics in patients treated with laparoscopic hysteromyomectomy

作　　者：许芾 岳洋 陈彪[3] 杨如宵 XU Fu;YUE Yang;CHEN Biao;YANG Ru-xiao(Department of Anesthesiology,Shenzhen Longhua District People′s Hospital,Shenzhen Guangdong 518109;Department of Obstetrics,Longhua District Maternal and Child Health Hospital,Shenzhen Guangdong 518110;Department of Anesthesiology and Surgery,The First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology,Baotou Inner Mongolia 014020,China)

机构地区：[1]广东省深圳市龙华区人民医院麻醉科,518109 [2]广东省深圳市龙华区妇幼保健院产科,518110 [3]内蒙古科技大学包头医学院第一附属医院麻醉手术科,内蒙古包头014020

出　　处：《蚌埠医学院学报》2020年第8期1008-1012,共5页Journal of Bengbu Medical College

基　　金：广东省科技计划项目(2017ZC0517)。

摘　　要：目的:研究七氟醚联合瑞芬太尼麻醉对腹腔镜下子宫肌瘤切除术病人应激反应及血流动力学的影响。方法:选取拟行腹腔镜下子宫肌瘤切除术病人100例作为研究对象,按随机数字表法将其分成观察组和对照组,各50例。对照组采用丙泊酚联合瑞芬太尼静脉复合麻醉,观察组则采用七氟醚联合瑞芬太尼静吸复合麻醉。分别对比2组在麻醉前5 min(T1)、气腹30 min(T2)、手术结束时(T3)的应激反应情况以及血流动力学变化情况,手术前1 d以及术后1 d认知功能情况,不良反应发生情况等方面的差异。结果:T2、T3时观察组的应激反应指标皮质醇、肾上腺素、去甲肾上腺素和血糖水平均低于对照组(P<0.01),血流动力学指标心率、平均动脉压和血氧饱和度水平也均低于对照组(P<0.01)。术后1 d观察组简易精神状态量表评分高于对照组(P<0.01),连线试验完成时间短于对照组(P<0.01)。观察组不良反应发生率低于对照组(P<0.05)。结论:七氟醚联合瑞芬太尼麻醉应用于腹腔镜下子宫肌瘤切除术病人中,可显著减轻机体应激反应,维持血流动力学的稳定,降低认知功能损害,且有利于避免不良反应的发生。Objective:To study the effects of sevoflurane combined with remifentanil anesthesia on stress response and hemodynamics in patients treated with laparoscopic hysteromyomectomy.Methods:One hundred patients scheduled by laparoscopic hysteromyomectomy were divided into the observation group and control group according to random number table method(50 cases in each group).The control group was intravenously anesthetized with propofol combined with remifentanil,while the observation group was anesthetized with sevoflurane combined with remifentanil.The differences of stress response and hemodynamic changes at 5 minutes before anesthesia(T1),30 minutes after pneumoperitoneum(T2)and at the end of operation(T3),cognitive function at 1 day before and after operation,and adverse reactions were compared between two groups.Results:At T2 and T3,the levels of cortisol,adrenaline,noradrenaline and blood glucose in observation group were lower than those in control group(P<0.01),and the heart rate,mean arterial pressure and blood oxygen saturation in observation group were lower than those in control group(P<0.01).On the first day after operation,the score of mini-mental state examination in observation group was higher than that in control group(P<0.01),while the completion time of trail making test in observation groupp was shorter than that in control group(P<0.01).The incidence of adverse reactions in observation group was lower than that in control group(P<0.05).Conclusions:The application of sevoflurane combined with remifentanil anesthesia in patients with laparoscopic hysteromyomectomy can significantly reduce the body′s stress response,maintain hemodynamic stability,reduce cognitive impairment,and help to avoid adverse reactions.

关 键 词：子宫肌瘤切除术 七氟醚 瑞芬太尼 应激反应 血流动力学 

分 类 号：R713[医药卫生—妇产科学]