丙泊酚-瑞芬太尼复合七氟醚在心脏外科手术中的麻醉效果研究

Anesthetic effects of propofol-remifentanil combined with sevoflurane in cardiac surgery

摘要:

目的 探究丙泊酚-瑞芬太尼复合七氟醚在心脏外科手术中的麻醉效果。方法 选取2022年9月—2024年9月陆军第七十一集团军医院接收的103例心脏外科手术患者，按信封抽签法随机分为对照组（51例）和复合组（52例）。对照组给予丙泊酚、瑞芬太尼麻醉维持，复合组给予七氟醚吸入复合丙泊酚、瑞芬太尼麻醉维持。比较两组一般资料、术中血流动力学、苏醒指标、术后视觉模拟评分法（VAS）评分及不良反应。结果 复合组与对照组T₀、T₁、T₂、T₃时MAP、HR比较，结果 ①不同时间点MAP、HR比较，差异均有统计学意义（P <0.05）；②复合组与对照组MAP、HR比较，差异均有统计学意义（P <0.05），复合组T₁、T₂时MAP高于对照组，T₁、T₂、T₃时HR低于对照组；③两组MAP变化趋势比较，差异有统计学意义（P <0.05）；两组HR变化趋势比较，差异无统计学意义（P >0.05）。复合组自主呼吸恢复时间、拔管时间、睁眼时间和语言应答时间均低于对照组（P <0.05）。复合组与对照组术后2、4、6 h的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复合组与对照组VAS评分比较，差异有统计学意义（P <0.05），复合组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 丙泊酚-瑞芬太尼复合七氟醚在心脏外科手术中的麻醉效果较为显著。

Abstract:

Objective To evaluate the anesthetic effects of propofol-remifentanil combined with sevoflurane in cardiac surgery.Methods A total of 103 patients undergoing cardiac surgery from September 2022 to September 2024 at the 71st Army Group Hospital were enrolled and randomly assigned via a sealed envelope method to either the control group (n = 51) or the combination group (n = 52). In the control group, anesthesia was maintained with propofol and remifentanil. In the combination group, anesthesia was maintained with inhaled sevoflurane combined with propofol and remifentanil. General characteristics, intraoperative hemodynamic parameters, recovery indicators, postoperative Visual Analog Scale (VAS) scores, and adverse reactions were compared between the two groups.Results A comparison of MAP and HR between the combination group and the control group at T₀, T₁, T₂, T₃ demonstrated that they were different across the time points (P < 0.05) and between the groups (P < 0.05). The MAP in the combination group was higher than that in the control group at T₁ and T₂, while the HR was lower than that in the control group at T₁, T₂, T₃. The change trend of MAP showed a statistically significant difference between the two groups (P < 0.05), whereas the change trend of HR showed no statistically significant difference (P > 0.05). The combination group had shorter times to spontaneous breathing recovery, extubation, eye opening, and verbal response compared with the control group (P < 0.05). A comparison of VAS scores between the combination group and the control group at 2, 4, and 6 hours postoperatively indicated that they were different across the time points (P < 0.05) and between the groups (P < 0.05). The combination group had lower VAS scores, indicating relatively better analgesic efficacy. The change trend of the VAS scores differed between the two groups (P < 0.05). There was no statistically significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusion The combination of propofol-remifentanil with sevoflurane provides significant anesthetic effects in cardiac surgery.