瑞芬太尼联合丙泊酚静脉麻醉在腹腔镜下腹股沟斜疝手术患儿麻醉中的应用及对血流动力学的影响  

Application of remifentanil combined with propofol intravenous anesthesia in children undergoing laparoscopic surgery for oblique inguinal hernia and its effect on hemodynamics

作　　者：张亮 尚志刚 Zhang Liang;Shang Zhigang(Department of Anesthesiology,Urumqi First People′s Hospital,Urumqi 830002,China)

机构地区：[1]乌鲁木齐市第一人民医院麻醉科,乌鲁木齐830002

出　　处：《中国医师杂志》2025年第1期47-51,共5页Journal of Chinese Physician

基　　金：新疆维吾尔自治区自然科学基金(2022D01A27)。

摘　　要：目的探讨瑞芬太尼与芬太尼分别联合丙泊酚静脉麻醉对腹腔镜下腹股沟斜疝手术患儿血流动力学及麻醉恢复质量的影响。方法选取2022年1月—2023年1月乌鲁木齐市第一人民医院收治的98例腹股沟斜疝患儿作为研究对象,根据1∶1比例的随机数字列表法,将患儿分为对照组和观察组,每组49例。对照组行芬太尼+丙泊酚麻醉,观察组行瑞芬太尼+丙泊酚麻醉,比较两组不同时点的血流动力学、麻醉恢复质量、应激反应指标及不良反应。结果观察组苏醒时间、拔管时间短于对照组(均P<0.05)。两组苏醒时Steward、15项恢复质量量表(QoR-15)评分比较差异无统计学意义(均P>0.05);出苏醒室时及术后24 h,两组Steward、QoR-15及修订版Wang-Baker面部表情疼痛评估量表(FPS-R)评分均较苏醒时升高,且观察组出苏醒室时及术后24 h的Steward、QoR-15评分高于对照组(均P<0.05)。观察组苏醒时、出苏醒室时及术后24 h的FPS-R评分低于对照组(均P<0.05)。两组T_(1)的平均动脉压、心率差异无统计学意义(均P>0.05);与T_(1)比较,两组T_(2)、T_(3)、T_(4)的平均动脉压、心率均出现明显波动(均P<0.05);与对照组比较,观察组T_(2)、T_(3)、T_(4)的平均动脉压、心率波动幅度明显较小(均P<0.05)。两组T_(1)的应激反应指标比较差异无统计学意义(均P>0.05);两组T_(2)、T_(3)、T_(4)的血清肾上腺素(E)、C反应蛋白(CRP)、皮质醇(Cor)水平均较T_(1)升高(均P<0.05);观察组T_(2)、T_(3)、T_(4)的血清E、CRP、Cor水平明显低于对照组(均P<0.05)。观察组总不良反应发生率低于对照组,差异有统计学意义(χ^(2)=4.159,P<0.05)。结论对腹腔镜下腹股沟斜疝手术患儿行瑞芬太尼联合丙泊酚静脉麻醉,可减轻对患儿血流动力学的影响,提高麻醉恢复质量,减轻机体应激反应。Objective To investigate the effects of remifentanil and fentanyl combined with propofol intravenous anesthesia on hemodynamics and quality of anesthesia recovery in children undergoing laparoscopic surgery for oblique inguinal hernia.MethodsA total of 98 children with oblique inguinal hernia admitted to the Urumqi First People′s Hospital from January 2022 to January 2023 were selected as the study objects,and randomly divided into control group and observation group with 49 cases in each group according to the 1∶1 ratio number list method.The control group received fentanyl+propofol anesthesia,and the observation group received remifentanil+propofol anesthesia.The hemodynamics,quality of anesthesia recovery,stress response indexes and adverse reactions were compared at different time points between the two groups.ResultsThe recovery time and extubation time of the observation group were shorter than those of the control group(P<0.05).There was no significant difference in Steward and 15-item Recovery Quality Scale(QoR-15)scores between the two groups(all P>0.05).The scores of Steward,QoR-15 and revised Wang Baker Facial Expression Pain Assessment Scale(FPSR)in both groups were higher than those in the recovery room and 24 h after surgery,and the scores of Steward and QoR-15 in the observation group were higher than those in the control group at the recovery room and 24 h after surgery(P<0.05).The FPSR scores of the observation group were lower than those of the control group at the time of recovery,exit from the recovery room and 24 h after operation(all P<0.05).There was no significant difference in mean arterial pressure and heart rate between the two groups at T_(1)(P>0.05).Compared with T_(1),the mean arterial pressure and heart rate of T_(2),T_(3) and T_(4) in both groups showed significant fluctuations(all P<0.05).Compared with the control group,the mean arterial pressure and heart rate of T_(2),T_(3) and T_(4) in the observation group were significantly smaller(all P<0.05).There was no significant dif

关 键 词：疝 腹股沟 腹腔镜检查 瑞芬太尼 丙泊酚 血流动力学 

分 类 号：R61[医药卫生—外科学]