七氟醚复合麻醉与异丙酚复合麻醉对腹腔镜妇科手术患者脑血流量及应激反应的影响  

Effects of sevoflurane combined anesthesia and propofol combined anesthesia on cerebral blood flow and stress response in patients undergoing laparoscopic gynecological surgery

作　　者：刘志杰 赵兴 李东兴[1] 高杨 吕航宇[1] 王新波[1] LIU Zhi-jie;ZHAO Xing;LI Dong-xing;GAO Yang;LYU Hang-yu;WANG Xin-bo(Department of Anesthesiology,Handan Central Hospital,Handan Hebei 056001,China;Department of Cardiology,Mingren hospital of Handan City,Handan Hebei 056006,China)

机构地区：[1]邯郸市中心医院麻醉科,河北邯郸056001 [2]邯郸市明仁医院心内科,河北邯郸056006

出　　处：《局解手术学杂志》2021年第8期694-697,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：河北省邯郸市科学技术研究与发展计划项目(1623208078ZC)。

摘　　要：目的探究七氟醚复合麻醉与异丙酚复合麻醉对腹腔镜妇科手术患者脑血流量及应激反应的影响。方法回顾性分析200例腹腔镜妇科手术患者的临床资料,按其术中麻醉方式分为七氟醚组和异丙酚组,七氟醚组106例患者采用七氟醚复合瑞芬太尼麻醉,异丙酚组94例患者采用异丙酚复合瑞芬太尼麻醉。比较2组患者麻醉效果,麻醉前、气腹后10 min、术后10 min脑血流量、脑短暂充血反应率及应激反应指标皮质醇(COR)、去甲肾上腺素(NE)水平。结果七氟醚组患者自主呼吸恢复时间、言语应答时间、睁眼时间、拔管时间、定向力恢复时间均短于异丙酚组患者(P<0.05);气腹后10 min、术后10 min七氟醚组患者脑血流量均低于异丙酚组患者(P<0.05),气腹后10 min七氟醚组患者脑短暂充血反应率高于异丙酚组患者(P<0.05);气腹后10 min、术后10 min七氟醚组患者COR及NE水平均低于异丙酚组患者(P<0.05)。结论与异丙酚复合瑞芬太尼麻醉比较,七氟醚复合瑞芬太尼麻醉运用于腹腔镜妇科手术的效果更好,能够减少患者脑血流量,且能有效减轻应激反应,是较为可靠的麻醉方式。Objective To explore the effects of sevoflurane combined anesthesia and propofol combined anesthesia on cerebral blood flow and stress response in patients undergoing laparoscopic gynecological surgery.Methods The clinical data of 200 patients who underwent laparoscopic gynecological surgery were retrospectively analyzed,and they were divided into the sevoflurane group and the propofol group according to the intraoperative anesthesia methods.A total of 106 patients in the sevoflurane group were anesthetized with sevoflurane combined with remifentanil,and 94 patients in the propofol group were anesthetized with propofol combined with remifentanil.The anesthesia effects,cerebral blood flow,brain transient hyperemia response rate and stress reaction index[cortisol(COR)and norepinephrine(NE)]levels before anesthesia,10 minutes after pneumoperitoneum,10 minutes after operation were compared between the two groups.ResultsThe recovery time of spontaneous breathing,speech response time,eye opening time,extubation time and recovery time of directional force in the sevoflurane group were all shoter than those in the propofol group(P<0.05).The cerebral blood flow in the sevoflurane group was lower than that in the propofol group 10 minutes after pneumoperitoneum and 10 minutes after operation(P<0.05),and the brain transient hyperemia response rate in the sevoflurane group was higher than that in the propofol group 10 minutes after pneumoperitoneum(P<0.05).The levels of COR and NE in the sevoflurane group were lower than those in the propofol group 10 minutes after pneumoperitoneum and 10 minutes after operation(P<0.05).Conclusion Compared with propofol combined with remifentanil anesthesia,sevoflurane combined with remifentanil anesthesia has a better effect in laparoscopic gynecological surgery,which can reduce patients’cerebral blood flow and effectively relieve stress response,and it is a relatively reliable anesthetic method.

关 键 词：七氟醚 异丙酚 复合麻醉 腹腔镜妇科手术 脑血流量 应激反应 

分 类 号：R713[医药卫生—妇产科学] R614.21[医药卫生—临床医学]