Effects Of Target-controlled And Non-target Control Of Sufentanil On Perioperative Hemodynamics And Stress In Gynecologic Laparoscopic Patients

Objective:In the total intravenous anesthesia,compared with the same dose of sufentanil target and non-target control of two different modes of administration,effects of these two modes of administration on perioperative hemodynamics and stress response in gynecologic laparoscopic patients.Methods:This study included a total of 36 cases of general anesthesia gynecological laparoscopic patients,ASA grade ?-?,anesthesia began to the end of the operation time 150-180min.The rats were randomly divided into two groups:group A,target-controlled infusion of sufentanil group(experimental group);group B,the first dose of sufentanil after intermittent bolus injection Administration(control group).Both groups were treated with tracheal intubation with intravenous anesthesia.Exclusion criteria:ASA?-? grade,obesity(BMI greater than 30kg/m2)Severe heart,liver,kidney dysfunction,opioid abuse history,history of mental illness,propofol or opioid allergy history.Anesthesia induction:Midazolam(0.02mg/kg)and etomidate(0.2 mg/kg)were injected intravenously with propofol(plasma concentration was set at 1.5 ug/ml and infusion time was 6 minutes),group A was given intraperitoneal injection of sufentanil(the effect of ventricular concentration was set to 0.5ng/ml),group B intravenous injection of sufentanil 0.5ug/kg.When propofol reached the target concentration,tracheal intubation was performed under visible laryngoscopy.Maintenance of anesthesia:At the beginning of the operation,the two groups were given a target-controlled infusion of remifentanil(the effect room concentration was set at 2 ng/ml).The plasma target concentration of propofol was adjusted according to the depth of anesthesia(BIS between 40-60)and the circulatory index.Group A was given target intraperitoneal injection of sufentanil(effect ventricular target concentration set to 0.2ng/ml),group B were before pneumoperitoneum and 1.5h after operation began,according to the cycle of fluctuations,Nepalese 0.1-0.2ug/kg sufentanil.Endoscopic infusion of sufentanil at the end of 30 minutes before surgery,discontinuation of propofol infusion after 20 min,and discontinuation of remifentanil infusion at the end of the procedure.The intraoperative fluid velocity was maintained at 6-8 ml/kg/h(crystal liquid:colloidal solution = 2:1).Monitoring indicators:Clinical indicators 1)hemodynamic parameters:heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP).2)General indicators:end-tidal carbon dioxide partial pressure(PetCO2),bispectral index(BIS),pulse blood saturation(SPO2).3)Other indicators:intraoperative use of narcotic drugs and vasoactive drugs,early recovery,the incidence of adverse events during surgery,postoperative VAS and OAA/S score.Laboratory indicators:serum epinephrine(EPI),serum cortisol(Cortisol).Time:T0:bedside value Ti:immediately before intubation T2:immediately after intubation T3:pneumoperitoneum before T4:pneumoperitoneum lmin T5:pneumoperitoneum after 10min T6:90 minutes after pneumoperitoneum T7:extubation immediately Tg:5 min after extubation.Monitoring point:T0:bedside value T1:immediately before intubation T2:immediately after intubation T3:before the pneumoperitoneum T4:1 minute after pneumoperitoneum T5:10 minute after pneumoperitoneum T6:90 minutes after pneumoperitoneum T7:extubation immediately T8:5 min after extubation.Result:(1)Compared with group B,SDP,DBP,MAP and HR were significantly slower than those in group B at the time of T6-8(P<0.05)?(2)Compared with group B,VAS score of group A was significantly lower than that of group B(P<0.05)?(3)Compared with group B,the time of postoperative respiratory recovery,awake time and extubation time in group A were significantly longer than those in group B(P<0.05).(4)Compared with group B,serum adrenaline and cortisol were significantly decreased in group A(P<0.05).(5)Compared with TO,SDP,DBP and MAP were significantly decreased in group A and B(P<0.05).ConclusionThe effect of sufentanil on the concentration of 0.5 ng/ml can effectively inhibit the intubation reaction.Target-controlled sufentanil(0.2ng/ml)can reduce the intraoperative stress response and maintain hemodynamics Learn to be stable,and get good postoperative analgesia,but can prolong anesthesia awakening time.