七氟烷-瑞芬太尼复合麻醉方案在腹腔镜子宫手术患者中的麻醉效果及对苏醒质量的影响  

Effect of sevoflurane remifentanil combined anesthesia on anesthesia effect and recovery quality of patients with hysteromyoma undergoing laparoscopic hysterectomy

作　　者：周璟 芦曼[1] 尹思捷 ZHOU Jing;LU Man;YIN Si-Jie(Depart merit oj Anesthesiology,Zhejiang Provincial Hospital of Traditional Chinese Mrdicine,Hangzhou,Zhejiang 310002,China)

机构地区：[1]浙江省中医院麻醉科,浙江杭州310002

出　　处：《中国妇幼保健》2022年第3期391-395,共5页Maternal and Child Health Care of China

基　　金：浙江省中医药科技计划项目(2020ZB097)。

摘　　要：目的分析七氟烷-瑞芬太尼复合麻醉方案对行腹腔镜子宫手术患者麻醉效果和苏醒质量的影响,为子宫肌瘤行腹腔镜子宫手术患者麻醉方案的选择提供参考。方法选取2018年3月—2020年8月在浙江省中医院行腹腔镜子宫手术的子宫肌瘤患者108例为研究对象。将其按照手术顺序编号,54例单号为对照组,行瑞芬太尼+丙泊酚静脉全麻手术;54例双号为观察组,行七氟烷吸入-瑞芬太尼+丙泊酚静注复合全麻手术。两组患者均由同一组手术医生和护士实施围术期手术和护理。对两组患者围麻醉期(麻醉诱导前、插管后1 min、气腹前、气腹后5 min及拔管时)舒张压(SBP)、收缩压(DBP)及心率(HR)进行监测比较;比较两组患者拔管时、拔管15 min及拔管30 min Steward评分和苏醒离开手术室时间。对两组患者术后1 d、3 d及7 d行简易精神状态量表(MMSE)测评,判断其是否发生术后认知功能障碍,并行组间比较。收集两组患者麻醉相关不良反应发生情况并行组间比较。结果两组患者麻醉诱导前、插管后1 min、气腹前、气腹后5 min及拔管时的SBP[对照组(131.17±8.13)mm Hg、(125.37±8.04)mm Hg、(121.39±7.67)mm Hg、(121.72±7.75)mm Hg及(121.81±7.48)mm Hg,观察组(132.30±9.35)mm Hg、(126.48±9.07)mm Hg、(122.48±8.16)mm Hg、(121.31±7.82)mm Hg及(121.97±7.53)mm Hg]、DBP[对照组(80.54±7.38)mm Hg、(79.76±7.07)mm Hg、(78.39±6.89)mm Hg、(77.40±6.35)mm Hg及(77.56±6.71)mm Hg,观察组(81.01±8.47)mm Hg、(80.05±7.58)mm Hg、(78.83±7.34)mm Hg、(77.07±6.47)mm Hg及(77.03±6.82)mm Hg]及HR[对照组(81.71±6.52)次/min、(81.97±6.43)次/min、(81.07±6.65)次/min、(81.03±6.67)次/min及(81.58±6.48)次/min,观察组(81.57±6.47)次/min、(81.54±6.52)次/min、(81.39±6.45)次/min、(81.83±6.81)次/min及(81.39±6.56)次/min]水平比较,差异均无统计学意义(SBP t=0.64、1.349、1.601、1.214及0.215,DBP t=0.574、1.414、1.102、1.227及1.016,HR t=0.322、0.448Objective To analyze the effect of sevoflurane remifentanil combined anesthesia on anesthesia effect and recovery quality of patients with hysteromyoma undergoing laparoscopic hysterectomy,and to provide reference for the optimization of anesthesia scheme for patients with hysteromyoma undergoing laparoscopic hysterectomy.Methods 108 patients with myoma who underwent laparoscopic hysterectomy in the hospital from March 2018 to February 2021 were selected as the research objects.According to the operation sequence,54 cases in the control group were given remifentanil combined with propofol intravenous anesthesia,and 54 cases in the observation group were given sevoflurane inhalation remifentanil combined with propofol intravenous injection combined general anesthesia.Two groups of patients by the same group of surgeons and nurses to implement perioperative surgery and nursing.The diastolic blood pressure(SBP),systolic blood pressure(DBP)and heart rate(HR)were monitored and compared between the two groups during the peri anesthesia period(before anesthesia induction,1 minute after intubation,before pneumoperitoneum,5 minutes after pneumoperitoneum and extubation);the steward score and Suxing’s time to leave the operating room were compared between the two groups.MMSE was used to evaluate the two groups on 1 day,3 days and 7 days after operation to judge whether they had postoperative cognitive dysfunction.The incidence of anesthesia related adverse reactions was collected and compared between the two groups.Results There were no significant differences in the levels of SBP[control group(131.17±8.13)mm Hg,(125.37±8.04)mm Hg,(121.39±7.67)mm Hg,(121.72±7.75)mm Hg,(121.81±7.48)mm Hg,observation group(132.30±9.35)mm Hg,(126.48±9.07)mm Hg,(122.48±8.16)mm Hg,(121.31±7.82)mm Hg,(121.97±7.53)mm Hg],DBP[control group(80.54±7.38)mm Hg,(79.76±7.07)mm Hg,(78.39±6.89)mm Hg,(77.40±6.35)mm Hg,(77.56±6.71)mm Hg,observation group(81.01±8.47)mm Hg,(80.05±7.58)mm Hg,(78.83±7.34)mm Hg,(77.07±6.47)mm Hg,(77.03±6.82

关 键 词：子宫肌瘤 腹腔镜子宫手术 七氟烷-瑞芬太尼复合麻醉 麻醉效果 苏醒质量 认知功能 

分 类 号：R711.74[医药卫生—妇产科学]