摘要
目的 探讨瑞芬太尼复合异丙酚靶控输注(TCI)对鼻内镜手术患者麻醉效果、血流动力学及应激反应的影响。方法 选择2019年5月至2021年5月在中国人民解放军空军军医大学第二附属医院拟行鼻内镜手术的140例患者进行研究,按随机数表法分为对照组和观察组,每组70例,对照组患者实行芬太尼复合七氟烷吸入麻醉,观察组患者实行瑞芬太尼复合异丙酚TCI麻醉。比较两组患者的麻醉起效时间、麻醉苏醒时间、自主呼吸时间、拔管时间;术前及术后1 d,比较两组患者的收缩期速度峰值(PSV),舒张末期血流速度(EDV),阻力指数(RI)、血流量、丙二醛(MDA)、超氧化物歧化酶(SOD)、皮质醇(CORT)水平;比较两组患者的不良反应发生情况。结果 观察组患者的麻醉起效和苏醒时间、自主呼吸时间、拔管时间分别为(1.23±0.28) min、(5.37±1.34) min、(4.05±0.84) min、(6.56±0.87) min,明显短于对照组的(3.16±0.84) min、(9.48±1.79) min、(6.78±1.03) min、(12.36±1.40) min,差异均具有统计学意义(P<0.05);术后1 d,观察组患者的MDA、SOD、CORT、RI水平分别为(5.34±1.57)μmol/L、(90.36±10.85) U/m L、(180.32±14.65) U/m L、0.67±0.09,明显低于对照组的(8.18±1.36)μmol/L、(102.66±11.52) U/m L、(195.13±12.94) U/mL、0.80±0.12,PSV、EDV、血流量水平分别为(50.17±5.08) cm/s、(9.52±1.16) cm/s、(38.23±7.36) mL/min,明显高于对照组的(43.69±4.94) cm/s、(9.00±1.08) cm/s、(33.80±7.11) mL/min,差异均有统计学意义(P<0.05);住院期间,观察组患者出现恶心、呕吐、头晕、腹胀、躁动、呼吸抑制的总发生率为7.14%,明显低于对照组的18.57%,差异有统计学意义(P<0.05)。结论 瑞芬太尼复合异丙酚TCI对鼻内镜手术患者的麻醉效果显著,其不仅能稳定患者的血流动力学水平,还能减少术后应激反应。
Objective To investigate the effects of remifentanil combined with propofol target-controlled in-fusion(TCI)on anesthesia,hemodynamics,and stress response of patients undergoing nasal endoscopic surgery.Methods A total of 140 patients receiving nasal endoscopic surgery in the Second Affiliated Hospital of the Military Medical University of the People's Liberation Army Air Force from May 2019 to May 2021 were selected for this study.The patients were randomly divided into a control group and an observation group,with 70 patients in each group.The control group was given fentanyl combined with sevoflurane inhalation anesthesia,and the observation group was given remifentanil combined with propofol TCI anesthesia.The onset time,recovery time,spontaneous breathing time,and ex-tubation time of the two groups were compared.Peak systolic velocity(PSV),end-diastolic blood flow velocity(EDV),resistance index(RI),blood flow,malondialdehyde(MDA),superoxide dismutase(SOD),and cortisol(CORT)levels of the two groups were compared before surgery and at 1 day after surgery.The occurrence of adverse reactions was com-pared between the two groups.Results The onset of anesthesia and recovery time,spontaneous breathing time,and ex-tubation time of the observation group were(1.23±0.28)min,(5.37±1.34)min,(4.05±0.84)min,(6.56±0.87)min,which were significantly shorter than(3.16±0.84)min,(9.48±1.79)min,(6.78±1.03)min,(12.36±1.40)min in the control group(P<0.05).At 1 d after surgery,the levels of MDA,SOD,CORT,and RI in the observation group were(5.34±1.57)μmol/L,(90.36±10.85)U/mL,(180.32±14.65)U/mL,0.67±0.09,which were significantly lower than(8.18±1.36)μmol/L,(102.66±11.52)U/mL,(195.13±12.94)U/mL,0.80±0.12 in the control group;PSV,EDV,and blood flow were(50.17±5.08)cm/s,(9.52±1.16)cm/s,(38.23±7.36)mL/min,which were significantly higher than(43.69±4.94)cm/s,(9.00±1.08)cm/s,(33.80±7.11)mL/min in the control group;the differences were statistically significant(P<0.05).During hospitalization,the total incidence of nausea,vomiting,dizziness,abdominal distention,agitation,and respiratory depression in the obser-vation group was 7.14%,which was significantly lower than 18.57%in the control group(P<0.05).Conclusion Remifen-tanil combined with propofol TCI has significant anesthetic effect on patients undergoing nasal endoscopic surgery,which can not only stabilize the hemodynamic level of patients,but also reduce postoperative stress response.
作者
张天庆
汪鸿
牛晶
ZHANG Tian-qing;WANG Hong;NIU Jing(Department of Anesthesiology,the Second Affiliated Hospital of the Military Medical University of the People's Liberation Army Air Force,Xi'an 710038,Shaanxi,CHINA)
出处
《海南医学》
CAS
2023年第10期1416-1419,共4页
Hainan Medical Journal
基金
国家自然科学基金(编号:81801391)。
关键词
鼻内镜手术
瑞芬太尼
异丙酚
靶控输注
麻醉效果
血流动力学
应激反应
Endoscopic nasal surgery
Remifentanil
Propofol
Target-controlled infusion
Anesthetic effect
He-modynamics
Stress response
