七氟醚或丙泊酚联合瑞芬太尼对腹腔镜腹股沟疝手术患者的影响分析  

Effect of Sevoflurane or Propofol Combined with Remifentanil on Patients Undergoing Laparoscopic Inguinal Hernia Surgery

作　　者：张达雷 侯桂婷 王欣[1] 李丹[1] ZHANG Dalei;HOU Guiting;WANG Xin(Suzhou Hospital Affiliated to Anhui Medical University,Suzhou Anhui 234000,China)

机构地区：[1]安徽医科大学附属宿州医院/安徽省宿州市立医院麻醉科,安徽宿州234000

出　　处：《河北医学》2021年第7期1108-1114,共7页Hebei Medicine

基　　金：安徽省自然科学基金项目,(编号:1808085MA21)。

摘　　要：目的:探讨七氟醚或丙泊酚联合瑞芬太尼对腹腔镜腹股沟疝手术患者的影响。方法:选择2018年8月至2020年8月我院接受腹腔镜手术的80例腹股沟疝患者进行研究,通过随机分配序列的工具表分为A组和B组,各40例。A组给予瑞芬太尼联合七氟醚进行麻醉维持,B组给予瑞芬太尼联合丙泊酚进行麻醉维持。比较两组围术期情况、不同时间点收缩压(SBP)、舒张压(DBP)、心率(HR)以及拔管后Steward苏醒评分的变化、切皮后呼吸商(RQs)、麻醉前及术毕时血浆皮质醇、血糖、促肾上腺皮质激素(ACTH)水平,并观察两组不良反应发生情况。结果:A组苏醒时间、拔管时间分别为(6.03±1.50)min、(9.34±1.63)min,均明显短于B组的(7.28±1.76)min、(12.30±2.04)min,有统计学意义(P<0.05);两组SBP、DBP、HR、Steward苏醒评分、切皮后RQs、血浆皮质醇、血糖、ACTH水平在组间、时间点比较均具有统计学意义(P<0.05),且均具有交互作用(P<0.05);两组插管后5min(T1)、人工气腹后15min(T2)、人工气腹后30min(T3)、手术结束时(T4)时间点时SBP、DBP、HR水平较手术前(T0)时点均升高,A组升高程度小于B组,差异均具有统计学意义(P<0.05);拔管时、拔管后10min时,A组Steward苏醒评分分别为(4.75±0.50)分、(5.21±0.37)分,均高于对照组的(4.22±0.47)分、(4.86±0.49)分,差异有统计学意义(P<0.05);在整个手术过程中,B组RQs均较A组降低,且0~1h时B组RQs较A组显著降低,(P<0.05)。术毕时两组血浆皮质醇、血糖、ACTH水平均较麻醉前显著升高(P<0.05);而术毕时B组血浆皮质醇、血糖、ACTH水平均较A组显著降低(P<0.05)。A组和B组不良反应合计率分别为15.00%和17.50%,比较无统计学意义(P>0.05)。结论:瑞芬太尼联合七氟醚在腹腔镜腹股沟疝手术中的麻醉效果显著,有助于保证术中血流平稳,缩短苏醒时间、拔管时间,提高苏醒质量,且安全性好。而丙泊酚在麻醉过程中可明显降低机体�Objective:To study the efficacy of remifentanil combined with sevoflurane and propofol in patients with laparoscopic inguinal hernia surgery.Methods:80 patients with inguinal hernia who underwent laparoscopic surgery in our hospital from August 2018 to August 2020 were selected,according to the tool list of random distribution sequence,they were divided into group A and group B,40 cases in each group.The group A was given remifentanil combined with sevoflurane for anesthesia maintenance,and group B was given remifentanil combined with propofol for anesthesia maintenance.The perioperative situation,systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),steward recovery score after extubation,respiratory quotient(RQs)after skin incision,plasma cortisol,blood glucose and adrenocorticotropic hormone(ACTH)levels before anesthesia and at the end of operation were compared between the two groups,and the incidence of adverse reactions was observed.Results:The recovery time and extubation time in group A were(6.03±1.50)min,(9.34±1.63)min,which were significantly shorter than those in group B(7.28±1.76)min,(12.30±2.04)min,with statistically significant(P<0.05).SBP,DBP,HR,steward wake-up score,RQs,plasma cortisol,blood glucose and ACTH levels of the two groups were statistically significant(P<0.05)and had interaction(P<0.05);SBP,DBP and HR levels at 5 min after intubation(T1),15 min after artificial pneumoperitoneum(T2),30 min after artificial pneumoperitoneum(T3)and at the end of operation(T4)in the two groups were higher than those before operation(T0),and the increase degree in group A was less than that in group B(P<0.05);At extubation and 10 minutes after extubation,the steward recovery score of group A was(4.751±50),(5.210±37),which were higher than(4.220±47),(4.860±49),the difference was statistically significant(P<0.05);During the whole operation,the RQs of group B was lower than that of group A,and the RQs of group B was significantly lower than that of group A at 0~1H(P<0.05).At the end

关 键 词：腹腔镜 腹股沟疝 瑞芬太尼 七氟醚 丙泊酚 麻醉效果 安全性 

分 类 号：R614[医药卫生—麻醉学]