七氟醚、丙泊酚联合瑞芬太尼在腹腔镜子宫肌瘤切除术中的应用

doi:10.3760/cma.j.issn.1007-1245.2023.03.015

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (3): 365-368.DOI: 10.3760/cma.j.issn.1007-1245.2023.03.015

七氟醚、丙泊酚联合瑞芬太尼在腹腔镜子宫肌瘤切除术中的应用

张冬宇徐国亭

南阳医学高等专科学校第一附属医院麻醉与围术期医学科手术部，南阳　473000

收稿日期:2022-10-09 出版日期:2023-02-01 发布日期:2023-03-03
通讯作者: 张冬宇，Email：zhangdongyuu@yeah.net
基金资助:
河南省医学科技攻关计划（联合共建）项目（LHGJ201801212）

Application effects of sevoflurane and propofol combined with remifentanil intravenous inhalation in laparoscopic myomectomy

Zhang Dongyu, Xu Guoting

Department of Anesthesia and Perioperative Medicine, The First Affiliated Hospital of Nanyang Medical College, Nanyang 473000, China

Received:2022-10-09 Online:2023-02-01 Published:2023-03-03
Contact: Zhang Dongyu, Email: zhangdongyuu@yeah.net
Supported by:
Medical Science and Technology Project (Joint Construction) of Henan Province (LHGJ201801212)

摘要/Abstract

摘要：

目的　探析对比不同静吸复合麻醉用药策略在腹腔镜子宫肌瘤切除术（LM）中的临床效果。方法　选择南阳医学高等专科学校第一附属医院2020年6月至2022年3月收治的127例LM患者作为研究对象，根据手术麻醉方案的不同将患者分为观察组［64例，年龄（43.47±5.28）岁］和对照组［63例，年龄（43.59±5.14）岁］。两组实施不同静吸复合用药策略，对照组给予丙泊酚+瑞芬太尼，观察组给予七氟醚+瑞芬太尼。对比两组麻醉安全性指标，麻醉前、术后10 min血流动力学指标［心率（HR）、平均动脉压（MAP）］及应激反应相关指标［去甲肾上腺素（NA）、血清皮质醇（COR）］，围麻醉期不良反应风险。计量资料比较采用t检验，计数资料采用χ²检验。结果　麻醉前两组MMSE评分分别为观察组（28.73±0.25）分比对照组（28.69±0.28）分，差异无统计学意义（t=0.850，P=0.397）；术后1 d两组MMSE评分分别为观察组（28.02±0.24）分比对照组（27.11±0.22）分，差异有统计学意义（t=22.264，P<0.001）。观察组瑞芬太尼用药剂量为（132.47±12.15）μg，低于对照组的（189.43±23.67）μg，差异有统计学意义（t=17.099，P<0.001）；观察组自主呼吸恢复时间为（5.47±1.25）min，短于对照组的（7.76±1.39）min，差异有统计学意义（t=9.766，P<0.001）。观察组围麻醉期不良反应发生率［3.13%（2/64）］明显低于对照组［14.29%（9/63）］（χ²=4.999，P=0.025）。结论　七氟醚+瑞芬太尼复合策略应用于LM效果明显优于丙泊酚+瑞芬太尼复合策略，可以减少瑞芬太尼用药剂量，降低对认知功能的影响、应激反应及不良反应风险，缩短自主呼吸恢复时间，维持相对稳定的血流动力学，值得临床推广。

关键词:

七氟醚, 丙泊酚, 瑞芬太尼, 静吸复合麻醉, 腹腔镜子宫肌瘤切除术

Abstract:

Objective　To explore and compare the clinical effects of different strategies of intravenous inhalation anesthesia in laparoscopic myomectomy (LM). Methods　A total of 127 patients undergoing LM admitted to The First Affiliated Hospital of Nanyang Medical College from June 2020 to March 2022 was selected as the research objects, and were divided into an observation group [64 cases, aged (43.47±5.28) years] and a control group [63 cases, aged (43.59±5.14) years] according to different surgical anesthesia plans. The two groups were given different intravenous inhalation anesthesia strategies: the control group was given propofol + remifentanil, and the observation group was given sevoflurane + remifentanil. The anesthesia safety indexes, hemodynamic indexes [heart rate (HR) and mean arterial pressure (MAP)] and stress response related indexes [norepinephrine (NA) and serum cortisol (COR)] before anesthesia and 10 min after surgery, and risk of adverse reactions in the peri-anesthetic period were compared between the two groups. t test was used for the measurement data and χ² test was used for the count data. Results　The MMSE scores of the two groups before anesthesia were (28.73±0.25) points in the observation group and (28.69±0.28) points in the control group, respectively, and there was no statistically significant difference (t=0.850, P=0.397); the MMSE scores of the two groups 1 d after surgery were (28.02±0.24) points in the observation group and (27.11±0.22) points in the control group, respectively, and the difference was statistically significant (t=22.264, P<0.001). The dose of remifentanil administered in the observation group was (132.47±12.15) μg, which was lower than that in the control group [(189.43±23.67) μg], with a statistically significant difference (t=17.099, P<0.001). The recovery time of spontaneous respiration in the observation group was (5.47±1.25) min, which was shorter than that in the control group [(7.76±1.39) min], with a statistically significant difference (t=9.766, P<0.001). The incidence of peri-anaesthesia adverse reactions in the observation group [3.13% (2/64)] was significantly lower than that in the control group [14.29% (9/63)] (χ²=4.999, P=0.025). Conclusion　The effect of sevoflurane + remifentanil compound medication strategy in LM is significantly better than that of propofol + remifentanil, which can reduce the dose of remifentanil administered, reduce the impact on cognitive function, stress response, and risk of adverse reactions, shorten the recovery time of spontaneous respiration, maintain relatively stable hemodynamics, and is worthy of clinical promotion.

Key words:

Sevoflurane, Propofol, Remifentanil, Intravenous inhalation anesthesia, Laparoscopic myomectomy

张冬宇徐国亭.

七氟醚、丙泊酚联合瑞芬太尼在腹腔镜子宫肌瘤切除术中的应用 [J]. 国际医药卫生导报, 2023, 29(3): 365-368.

Zhang Dongyu, Xu Guoting.

Application effects of sevoflurane and propofol combined with remifentanil intravenous inhalation in laparoscopic myomectomy [J]. International Medicine and Health Guidance News, 2023, 29(3): 365-368.

参考文献

[1] 张海亮,郝静静,白延斌,等.静吸复合与全凭静脉麻醉在妇科腹腔镜手术中的临床应用研究[J].陕西医学杂志,2019,48(8):1038-1041. DOI:10.3969/j.issn.1000-7377.2019. 08.022.
[2] 刘新法,张杰,马鹏,等.瑞芬太尼在腹腔镜子宫肌瘤切除术中的应激反应及安全性评价[J].西部医学,2018,30(2):250-253,256. DOI:10.3969/j.issn.1672-3511.2018.02.024.
[3] 夏树红,刘荣,桂新星,等.舒芬太尼联合丙泊酚麻醉对子宫肌瘤切除术后患者血流动力学、应激反应的影响[J].腹腔镜外科杂志,2019,24(12):952-956. DOI:10.13499/j.cnki.fqjwkzz.2019.12.952.
[4] 贺艳兰,彭七华,刘海根.丙泊酚与七氟醚对腹腔镜子宫肌瘤切除术患者胰岛功能的影响[J].海南医学,2018,29(12):1679-1682. DOI:10.3969/j.issn.1003-6350.2018.12.016.
[5] 许芾,岳洋,陈彪,等.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[J].蚌埠医学院学报,2020,45(8):1008-1012. DOI:10.13898/j.cnki.issn.1000-2200.2020.08.005.
[6] 子宫肌瘤的诊治中国专家共识专家组.子宫肌瘤的诊治中国专家共识[J].中华妇产科杂志,2017,52(12):793-800. DOI:10.3760/cma.j.issn.0529-567x.2017.12.001.
[7] 陈靖军,赵向波,勾志静,等.静吸复合麻醉与单纯静脉麻醉对老年子宫肌瘤腹腔镜切除术患者认知功能及应激指标影响[J].中国计划生育学杂志,2020,28(1):76-79. DOI:10.3969/j.issn.1004-8189.2020.01.018.
[8] 陆梅艳,任默,安沛兴,等.瑞芬太尼对腹腔镜子宫肌瘤切除术患者应激反应和认知功能的影响[J].中国肿瘤临床与康复,2020,27(12):1440-1443. DOI:10.13455/j.cnki.cjcor. 2020.12.08.
[9] 丁雷鸣,李军,郑珍慧,等.七氟醚复合瑞芬太尼对腹腔镜子宫肌瘤切除术患者应激反应、血流动力学及认知功能的影响[J].中国医刊,2018,53(6):646-649. DOI:10.3969/j.issn.1008-1070.2018.06.020.
[10] 赵艳,唐慧敏.靶控输注不同低效应室浓度舒芬太尼复合丙泊酚用于腹腔镜手术麻醉的效果[J].中华麻醉学杂志,2020,40(7):830-833. DOI:10.3760/cma.j.cn131073. 20200328.00715.
[11] 邱洁,孙虎,谢爽,等.丙泊酚麻醉对老龄大鼠认知功能和海马神经元γ-氨基丁酸A受体表达的影响[J].实用临床医药杂志,2021,25(4):45-48,51. DOI:10.7619/jcmp.20201604.
[12] 张俊.瑞芬太尼复合异丙酚全麻在高危妊娠妇女剖宫产麻醉中的应用[J].哈尔滨医药,2021,41(1):88-89.
[13] 艾金莲,肖金辉,刘荣,等.七氟醚联合瑞芬太尼麻醉对腹腔镜下子宫肌瘤切除术患者应激反应及血流动力学的影响[J].中国医药导报,2019,16(31):103-106.
[14] 章慧,汪计秀.七氟醚对开颅血肿清除术患者的麻醉效果及血流动力学的影响研究[J].国际医药卫生导报,2021,27(7):1062-1066.DOI:10.3760/cma.j.issn.1007-1245.2021. 07.031.
[15] 刘立鹏.吸入和静脉麻醉对老年冠心病患者术后不良心血管事件的影响[J].广州医药,2022,53(4):133-135,139. DOI:10.3969/j.issn.1000-8535.2022.04.030.
[16] 韩宝义,张悦,胡祖荣,等.七氟醚对子痫前期母体炎性因子及SENG蛋白表达影响[J].现代医院,2021,21(4):633-635,639. DOI:10.3969/j.issn.1671-332X.2021.04.041.

七氟醚、丙泊酚联合瑞芬太尼在腹腔镜子宫肌瘤切除术中的应用

Application effects of sevoflurane and propofol combined with remifentanil intravenous inhalation in laparoscopic myomectomy

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