瑞芬太尼与舒芬太尼靶控输注对老年患者行腹腔镜胃癌根治术麻醉恢复质量的影响

Comparison of the quality of anesthesia recovery between Remifentanil and Sufentanil target-controlled infusion in elderly patients undergoing laparoscopic radical gastrectomy

摘要:

摘要：目的??比较靶控输注瑞芬太尼和舒芬太尼对老年患者行腹腔镜胃癌根治术麻醉恢复的质量。方法?选取2016年9月－2018年12月该院腹腔镜胃癌根治术患者84例，随机分为舒芬太尼组（n =42）和瑞芬太尼组（n =42）。两组患者应用靶控输注舒芬太尼和瑞芬太尼为基础的麻醉。记录并比较两组患者唤醒时间、拔管时间、定向力恢复时间、生命体征、应激反应、T细胞亚群分布及不良反应发生率。结果?两组患者定向力恢复时间差异无统计学意义（P >0.05）。舒芬太尼组的清醒和拔管时间明显短于瑞芬太尼组，差异均有统计学意义（P <0.05）。舒芬太尼组麻醉结束、麻醉诱导后和麻醉前的心率（HR）、平均动脉压（MAP）和脉搏血氧饱和度（SpO2）比较，差异均无统计学意义（P >0.05），而瑞芬太尼组麻醉结束、麻醉诱导后和麻醉前的HR、MAP和SpO2比较，差异均有统计学意义（P <0.05）。舒芬太尼组在麻醉后、麻醉结束、麻醉结束24 h和麻醉结束72 h 4个时间点，血葡萄糖（GLU）、皮质醇（Cor）、白细胞介素-6（IL-6）和C反应蛋白（CRP）的浓度均明显低于瑞芬太尼组，CD3+、CD4+和CD8+及CD4+/CD8+明显高于瑞芬太尼组，瑞芬太尼组麻醉不良反应发生率明显高于舒芬太尼组，差异有统计学意义（P <0.05）。结论?对于接受腹腔镜胃癌根治术的老年患者，靶控输注舒芬太尼为基础的麻醉具有麻醉过程平稳、应激反应小、抑制细胞免疫轻和不良反应少等优点，值得临床推广。

Abstract:

Abstract: Objective?To compare the quality of anesthesia recovery between target-controlled infusion of Remifentanil and Sufentanil in elderly patients underwent laparoscopic radical gastrectomy for gastric cancer. ?Methods?Eighty-four elderly patients who underwent laparoscopic radical gastrectomy for gastric cancer from September 2016 to December 2017 were randomly divided into the Sufentanil and Remifentanil groups (n = 42 per group). The two groups used Sufentanil- and Remifentanil-based anesthesia by TCI. The wake-up time, extubation time, orientation recovery time, vital signs, stress response, distribution of T-cell subsets and incidence of adverse reactions were recorded and compared.?Results?The difference of orientation recovery time was not statistically significant (P > 0.05). The wake-up and extubation times of the Sufentanil group were significantly shorter than those of the Remifentanil group (P < 0.05). The differences in heart rate, mean arterial pressure, and arterial oxygen saturation following anesthesia and during surgery and those prior to anesthesia of the Sufentanil group were not statistically significant. However, those of the difference of Remifentanil group was statistically significant (P < 0.05). The concentrations of GLU, Cor, IL-6 and CRP in Sufentanil group were significantly lower than those in Remifentanil group at four time points after anesthesia, end of anesthesia 24 hours after anesthesia and 72 hours after anesthesia. CD3+, CD4+ and CD8+ T cell subsets and CD4+ / CD8+ in Remifentanil group were significantly higher than those in Remifentanil group at four time points after anesthesia, end of anesthesia 24 hours after anesthesia and 72 hours after anesthesia. The adverse reactions rate during anesthesia of the Remifentanil group was significantly higher than that of the Sufentanil group (P < 0.05).?Conclusion?For elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer, target-controlled infusion of Sufentanil-based anesthesia have the advantages of stable anesthesia process, low stress response, light inhibition of cellular immunity and less adverse reactions, which is worthy of clinical promotion.