靶控输注舒芬太尼复合七氟烷全麻在腹腔镜手术中的应用:前瞻性随机对照研究

Abstract

目的探讨低浓度舒芬太尼靶控输注(target-controlled infusion,TCI)复合七氟烷全麻的效果。方法 2015年9～12月择期全麻下腹腔镜手术40例(18～68岁,ASAⅠ级或Ⅱ级),根据麻醉维持期舒芬太尼效应室靶浓度不同随机分为2组:0. 10 ng/ml(Ⅰ组)和0. 25 ng/ml(Ⅱ组),每组20例。麻醉诱导采用舒芬太尼TCI、丙泊酚TCI和罗库溴铵静脉注射。麻醉维持采用舒芬太尼TCI复合吸入七氟烷,间断静脉注射罗库溴铵维持肌肉松弛。比较2组基础值、气管插管后1 min、气腹后10 min、气腹后30 min、开始缝合切口时、气管拔管前即刻和拔管后1 min平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脑电双频指数(bispectral index,BIS),以及麻醉后苏醒情况和术后24 h内不良反应。结果 2组手术时间、麻醉维持期使用麻黄碱、阿托品例数及拔管时间差异无显著性(P> 0. 05),Ⅰ组TCI时间明显长于Ⅱ组,舒芬太尼用量明显小于Ⅱ组(P <0. 05)。围术期2组MAP和HR较平稳,BIS值适宜。Ⅱ组患者术中HR气腹后10 min [(62. 2±6. 1)次/min vs.(68. 3±8. 0)次/min,t=2. 709,P=0. 000]、气腹后30 min [(59. 1±5. 0)次/min vs.(67. 6±7. 4)次/min,t=4. 224,P=0. 000]和开始缝合切口时[(59. 0±6. 6)次/min vs.(66. 6±6. 4)次/min,t=3. 721,P=0. 001]明显慢于Ⅰ组。2组均无肌肉僵直、躁动、呼吸抑制或术中知晓发生,2组术后拔管时间、恶心呕吐及使用镇痛药例数差异无显著性(P> 0. 05)。结论低浓度舒芬太尼TCI复合七氟烷可以安全、有效地用于全麻腹腔镜手术患者。

Objective To investigate effects of target-controlled infusion( TCI) of sufentanil at low concentration combined with sevoflurane in general anesthesia. Methods Forty patients with American Society of Anesthesiologists( ASA) physical statusⅠ or Ⅱ,aged 18-68 years,scheduled for elective laparoscopic surgery under general anesthesia,were included in this study conducted from September to December 2015. The anesthesia was induced with sufentanil TCI combined with propofol TCI,and intravenous injection of rocuronium. The patients were randomly divided into two groups with 20 patients in each group: during maintenance of anesthesia,target effect-site concentration of sufentanil was set at 0. 10 ng/ml( Group Ⅰ) or 0. 25 ng/ml( GroupⅡ),respectively. The anesthesia was maintained with sufentanil TCI combined with inhalation of sevoflurane,and intermittent intravenous boluses of rocuronium as needed to maintain muscle relaxation. The mean arterial pressure( MAP),heart rate( HR),and bispectral index( BIS) at the time points of baseline,1 min after tracheal intubation,10 min and 30 min after pneumoperitoneum,start of wound suture,just before tracheal extubation,and 1 min after tracheal extubation,as well as recovery profile after anesthesia and adverse effects within 24 h after surgery,were observed. Results There were no significant differences in operation time,number of cases of ephedrine and atropine used during maintenance of anesthesia,and extubation time between the two groups( P >0. 05). As compared with the group Ⅱ,the group Ⅰ had significant longer TCI time and less use of sufentanil( P < 0. 05). All the patients in both groups had comparatively stable MAP and HR,as well as suitable BIS variables during perioperative stage. The HR values were lower in the group Ⅱ than those in the group Ⅰ at the time point of 10 min after pneumoperitoneum [( 62. 2 ± 6. 1)beats/min vs.( 68. 3 ± 8. 0) beats/min,t = 2. 709,P = 0. 000],30 min after pneumoperitoneum [( 59. 1 ± 5. 0) beats/min vs.( 67. 6 ± 7. 4) beats/min,t = 4. 224,P = 0. 000],and start of wound suture [( 59. 0 ± 6. 6) beats/min vs.( 66. 6 ± 6. 4) beats/min,t = 3. 721,P = 0. 001]. There were no episode of muscle rigidity,agitation,respiratory depression,or intraoperative awareness. There were no significant differences in postoperative extubation time,postoperative nausea and vomiting,and the use of analgesics between the two groups( P > 0. 05). Conclusion Sufentanil TCI at low concentration combined with sevofluranecan is a safe and efficient management of general anesthesia in laparoscopic surgical patients.