高级检索

    不同阿片类药物联合瑞马唑仑用于输尿管钬激光碎石术的有效性研究

    Study on the effectiveness of different opioid drugs combined with remifentanil in holmium laser lithotripsy of the ureter

      摘要
    • 摘要:
      目的 探讨不同阿片类药物联合瑞马唑仑用于输尿管钬激光碎石术的麻醉效果。
      方法 将80例拟行经尿道钬激光碎石病人采用随机数字表法分为A组(40例)、B组(40例)。A组病人手术期间接受阿芬太尼联合瑞马唑仑麻醉，B组接受舒芬太尼联合瑞马唑仑麻醉。记录2组手术时间、停药后睁眼时间、喉罩拔除时间、术后24 h疼痛评分、住院时间；记录不同时间点麻醉诱导前(T0)、喉罩置入时(T1)、手术开始时(T2)、喉罩拔除时(T3)的平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)；对比T0、成功诱导后30 min(T4)、成功诱导后60 min(T5)3个时间点的血清炎症因子水平C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)；对比停药后10 min、30 min的Steward苏醒评分、改良的OAA/S评分及不良反应发生率。
      结果 A组停药后睁眼时间和喉罩拔除时间均短于B组(P < 0.01和P < 0.05)，2组的手术时间、术后疼痛评分、术后住院时间差异均无统计学意义(P＞0.05)。2组病人T0、T1、T2、T3时间点的MAP、HR、BIS进行比较：组间各时间点水平差异均无统计学意义(P＞0.05)；组内不同时间点A、B两组的BIS水平差异均具有统计学意义(P < 0.01)，MAP和HR 2个指标组内各时间点差异均无统计学意义(P＞0.05)。CRP、IL-6、TNF-α水平在组内T0、T4、T5时间点比较结果显示，A组的CRP和TNF-α水平差异无统计学意义(P＞0.05)，IL-6水平差异有统计学意义(P < 0.01)，B组3个指标组内不同时间点差异均有统计学意义(P < 0.01)，随着时间的推移呈上升趋势；组间比较显示，除IL-6在T4时间点差异无统计学意义外(P＞0.05)，T3、T5时间点3个指标水平A组均低于B组(P < 0.01)。A组停药后10 min、30 min的Steward苏醒评分和改良的OAA/S评分均高于B组(P < 0.01)；A组、B组不良反应发生率差异均无统计学意义(P＞0.05)。
      结论 阿芬太尼联合瑞马唑仑与舒芬太尼联合瑞马唑仑对输尿管钬激光碎石病人的麻醉效果相当，术后恢复效果良好、安全性高，且对炎症反应的抑制效果显著。

       

      Abstract:
      Objective To investigate the anesthetic effects of different opioid drugs combined with remifentanil for holmium laser lithotripsy of the ureter.
      Methods Eighty patients scheduled by transurethral holmium laser lithotripsy were randomly divided into the group A(40 cases) and group B(40 cases) using a random number table method.Group A received anesthesia with fentanyl combined with remifentanil during surgery, while group B received anesthesia with sufentanil combined with remifentanil.The operation time, eye opening time after discontinuation of medication, laryngeal mask removal time, 24-hour postoperative pain score and hospital stay in two groups were recorded.The mean arterial pressure(MAP), heart rate(HR) and bispectral index(BIS) at different time points before anesthesia induction(T0), during laryngeal mask insertion(T1), at the beginning of surgery(T2) and during laryngeal mask removal(T3) in two groups were recorded.The serum levels of inflammatory factorsC-reactive protein(CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) at T0, 30 minutes after successful induction(T4) and 60 minutes after successful induction(T5) were compared between two groups.The Steward recovery score, modified OAA/S score, and incidence of adverse reactions at 10 minutes and 30 minutes after discontinuation of medication were compared.
      Results The eye opening time and laryngeal mask removal time in group A were shorter than those in group B after discontinuation of medication(P < 0.01 and P < 0.05).There was no statistical significance in the surgical time, postoperative pain score and postoperative hospitalization time between two groups(P > 0.05).The MAP, HR and BIS in two groups at time points T0, T1, T2 and T3 were compared, and there was no statistical significance in the levels at each time point between two groups(P > 0.05).The differences in the BIS levels in two groups at different time points were statistically significant(P < 0.01), while there was no statistical significance in the MAP and HR at each time point within group(P > 0.05).The comparison results of CRP, IL-6 and TNF-α levels at time points T0, T4 and T5 within the group showed that there was no statistical significance in the CRP and TNF-α levels in group A(P > 0.05), while there was statistical significance in the IL-6 levels(P < 0.01).The differences of the three indicators in group B at different time points were statistically significant(P < 0.01), and showed an upward trend over time.The intergroup comparison showed that except for IL-6, which had no statistically significant difference at time point T4(P > 0.05), the levels of the three indicators at time points T4 and T5 in group A were all lower than those in group B(P < 0.01).The Steward recovery scores and modified OAA/S scores in group A at 10 minutes and 30 minutes after drug withdrawal were higher than those in group B(P < 0.01).There was no statistical significance in the incidence of adverse reactions between two groups(P > 0.05).
      Conclusions The anesthetic effects of fentanyl combined with remifentanil and sufentanil combined with remifentanil on patients treated with holmium laser lithotripsy of the ureter are comparable.The postoperative recovery effect is good, the safety is high, and the inhibitory effect on inflammatory response is significant.

       

      • HTML全文
      • 参考文献(15)
      • 相关文章
      • 施引文献
    • 资源附件(0)

    /

    返回文章
    返回