Abstract:

Objective　To evaluate the safety and efficacy of sevoflurane combined with remifentanil in patients undergoing thoracoscopic lobectomy. Methods　This was a randomized controlled trial. A total of 86 patients who underwent thoracoscopic lobectomy in Shenmu Hospital from January 2021 to October 2023 were included and were divided into two groups according to the random number table method. One group received conventional analgesic drugs (sevoflurane group), the other group received sevoflurane combined with remifentanil (combined group), with 43 cases in each group. In the sevoflurane group, there were 23 males and 20 females, aged (28.14±4.65) years. In the combined group, there were 25 males and 17 females, aged (29.57±4.64) years. The sevoflurane group received sevoflurane inhalation anesthesia, and the concentration was maintained at 1.2-2.0 MAC (minimum alveolar concentration) to ensure sufficient depth of anesthesia. Anesthesia induction in the combined group was the same as that in the sevoflurane group. Sevoflurane inhalation anesthesia was used for maintenance anesthesia, but the concentration was maintained at 0.7-1.5 MAC, which was slightly lower than that in the sevoflurane group. Analgesia was maintained by adding remifentanil on the basis of sevoflurane to improve the analgesia effect, and remifentanil was continuously transfused at a rate of 0.2-0.5 μg/(kg·h). The differences in analgesic effects [rescue analgesia rate and Visual Analogue Scale (VAS) score], sleep quality indicators [arousal index (AI), sleep efficiency index (SEI), and proportion of rapid eye movement sleep time (REM)], inflammatory indexes [interleukin (IL)-1, IL-6, IL-10, C-reactive protein (CRP), and tumor necrosis factor α (TNF-α)], and adverse reactions were compared between the two groups. Independent sample t test and χ² test were used. Results　Compared with those in the sevoflurane group, the rescue analgesia rate was lower in the combined group [11.63% (5/43) vs. 30.23% (13/43)]; 1, 24, and 48 h after surgery, the VAS score of the combined group was lower [(5.16±1.52) points vs. (6.53±1.82) points, (2.69±1.11) points vs. (3.41±1.31) points, (1.25±0.66) points vs. (1.57±0.62) points], with statistically significant differences (all P<0.05). The AI and SEI at night in the combined group were lower than those in the sevoflurane group 1 d after surgery (both P<0.05). The levels of IL-6, IL-10, IL-1β, TNF-α, and CRP in the combined group were lower than those in the sevoflurane group 1 d after surgery, with statistically significant differences (all P<0.05). The total incidence of adverse reactions in the combined group was lower than that in the sevoflurane group [4.65% (2/43) vs. 18.60% (8/43)], with a statistically significant difference (χ²=4.074, P=0.044). Conclusions　Sevoflurane combined with remifentanil in patients undergoing thoracoscopic lobectomy can significantly improve the analgesic effect and sleep quality while reducing the inflammatory response. This analgesic scheme is safe and effective.

Key words:

Sevoflurane, Remifentanil, Thoracoscopic lobectomy, Analgesia, Sleep

摘要：

目的　评估七氟醚复合瑞芬太尼对行胸腔镜肺叶切除术患者的安全性与有效性。方法　本研究为随机对照试验，共纳入2021年1月至2023年10月神木市医院行胸腔镜肺叶切除术的患者86例，根据随机数字表法分为两组。一组使用常规镇痛药物（七氟醚组），一组使用七氟醚复合瑞芬太尼（复合组），各43例。七氟醚组男23例，女20例，年龄（28.14±4.65）岁；复合组男25例，女17例，年龄（29.57±4.64）岁。七氟醚组采用七氟醚吸入麻醉，调整浓度维持在1.2～2.0 MAC（最小肺泡浓度），以保证足够的麻醉深度；复合组麻醉诱导同七氟醚组，维持麻醉采用七氟醚吸入麻醉，但浓度调整为0.7～1.5 MAC，较七氟醚组略低，镇痛维持在七氟醚基础上加入瑞芬太尼以提高镇痛效果，瑞芬太尼以0.2～0.5 μg/（kg·h）的速率持续输注。比较两组患者的镇痛效果［补救镇痛率、视觉模拟评分法（VAS）评分］、睡眠质量指标［觉醒指数（AI）、睡眠效率指数（SEI）及快速眼动睡眠时间比例（REM）］、炎症指标［白细胞介素（IL）-1、IL-6、IL-10、C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）］及不良反应的差异。采用独立样本t检验、χ²检验。结果　与七氟醚组比较，复合组患者补救镇痛率更低［11.63%（5/43）比30.23%（13/43）］；术后1、24、48 h，复合组VAS评分更低［（5.16±1.52）分比（6.53±1.82）分、（2.69±1.11）分比（3.41±1.31）分、（1.25±0.66）分比（1.57±0.62）分］，差异均有统计学意义（均P<0.05）。复合组术后1 d夜晚的AI、SEI低于七氟醚组（均P<0.05）。复合组术后1 d时IL-6、IL-10、IL-1β、TNF-α和CRP水平均低于七氟醚组，差异均有统计学意义（均P<0.05）。复合组患者的不良反应总发生率低于七氟醚组［4.65%（2/43）比18.60%（8/43）］，差异有统计学意义（χ²=4.074，P=0.044）。结论　七氟醚复合瑞芬太尼用于行胸腔镜肺叶切除术的患者，可以显著改善镇痛效果和睡眠质量，同时减轻炎症反应，该方案镇痛安全有效。

关键词:

七氟醚, 瑞芬太尼, 胸腔镜肺叶切除术, 镇痛, 睡眠