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

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