舒芬太尼联合盐酸纳美芬在腹腔镜妇科肿瘤手术中的麻醉效果及对患者肺功能的影响

Anesthetic effects of sufentanil combined with nalmefene hydrochloride in laparoscopic surgery for gynecological tumors and its impact on the lung function of patients

摘要:

目的 评估舒芬太尼联合盐酸纳美芬在腹腔镜妇科肿瘤手术中的麻醉效果及对患者肺功能的影响。方法 选取2022年10月—2023年12月在沧州市人民医院进行腹腔镜妇科肿瘤手术的患者64例，通过随机数字表法将患者分为观察组和对照组，每组32例。对照组患者采用舒芬太尼+托烷司琼+右美托咪定的镇痛方式，观察组在对照组基础上联合盐酸纳美芬。比较两组患者麻醉前（T₀）、切口缝合后10 min（T₁）、术后1 h（T₂）的血流动力学［收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率］，记录两组患者的苏醒时间（睁眼时间、自主呼吸恢复时间、定向力恢复时间），以及术后2、12和24 h的视觉模拟量表（VAS）评分，测定术前和术后24 h的炎症因子水平［血清白细胞介素-6（IL-6）、IL-8、肿瘤坏死因子-α（TNF-α）］和肺功能指标［用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、呼气峰值流速（PEF）］，并通过简明精神状态量表（MMsE）和蒙特利尔认知评估量表（MoCA）评估其认知功能。结果 观察组与对照组术后T₀、T₁、T₂的SBP、DBP、MAP和心率比较，结果 ①不同时间点SBP、DBP、MAP和心率比较，差异均有统计学意义（P <0.05）；②观察组与对照组SBP、DBP、MAP和心率比较，差异均无统计学意义（P >0.05）；③两组SBP、DBP、MAP和心率变化趋势比较，差异均有统计学意义（P <0.05）。观察组患者睁眼时间、自主呼吸恢复时间和定向力恢复时间均短于对照组（P<0.05）。观察组与对照组术后2、12和24 h静息状态下VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组VAS评分比较，差异有统计学意义（P <0.05），观察组VAS评分较低；③两组VAS评分变化趋势比较，差异无统计学意义（P >0.05）。观察组手术前后IL-6、IL-8、TNF-α、FVC、FEV₁、PEF、MMSE和MoCA评分的差值均低于对照组（P <0.05）。结论 腹腔镜妇科肿瘤手术中联合应用盐酸纳美芬有助于降低患者疼痛程度，提高术后肺功能。

Abstract:

Objective To evaluate the anesthetic effects of sufentanil combined with nalmefene hydrochloride in laparoscopic surgery for gynecological tumors and its impact on the lung function of patients.Methods Sixty-four patients who underwent laparoscopic surgery for gynecological tumors from October 2022 to December 2023 in our hospital were selected. Through the random number table method, all patients were divided into an observation group and a control group, each with 32 patients. The control group received sufentanil, tropisetron, and dexmedetomidine for analgesia, while the observation group was additionally given nalmefene hydrochloride. Hemodynamic parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate) ] before anesthesia (T₀), 10 minutes after incision suture (T₁), and 1 hour postoperatively (T₂) were compared between the two groups. The recovery times (time to eye opening, time to recovery of spontaneous breathing, and time to recovery of orientation), and pain scores as assessed via Visual Analogue Scale (VAS) 2 hours, 12 hours, and 24 hours after surgery were recorded. The levels of inflammatory factors [serum interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α], and pulmonary function indices [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), peak expiratory flow (PEF) ] before and 24 hours after surgery were measured. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales.Results Comparisons of SBP, DBP, MAP, and heart rate at T₀, T₁, and T₂ between the observation group and the control group showed that they were different among the time points (P < 0.05) but not between the observation group and the control group (P > 0.05), and that the change trends of SBP, DBP, MAP, and heart rate were different between the two groups (P < 0.05). The time to eye opening, time to recovery of spontaneous breathing, and time to recovery of orientation were all shorter in the observation group than in the control group (P < 0.05). Comparisons of VAS scores at rest 2 hours, 12 hours, and 24 hours postoperatively between the observation group and the control group showed that VAS scores were different among the time points (P < 0.05) and between the groups (P < 0.05), with lower scores in the observation group. Besides, there were no significant differences in the change trends of VAS score between the two groups (P > 0.05). The differences of the levels of IL-6, IL-8, and TNF-α, FVC, FEV₁, PEF, and MMSE and MoCA scores before and after treatment were lower in the observation group than in the control group (P < 0.05).Conclusions The combined use of nalmefene hydrochloride in laparoscopic surgery for gynecological tumors is conducive to alleviating the pain of patients and improving postoperative pulmonary function.