汪启明 梅楷波 熊归翔

【摘要】 目的：观察瑞芬太尼复合丙泊酚对腹腔镜结直肠癌根治术患者术中血流动力学及术后肠道运动功能的影响。方法：回顾性抽取上饶市人民医院于2021年6月—2023年6月收治的60例结直肠癌并行腹腔镜根治术患者，根据麻醉方式不同分为对照组与研究组，其中对照组29例使用芬太尼复合丙泊酚麻醉，研究组31例使用瑞芬太尼复合丙泊酚麻醉。对比两组围手术期指标、血流动力学、术后认知功能[简易智能精神状态检查量表（MMSE）评估]、肠道运动功能、不良反应。结果：两组手术时间比较，差异无统计学意义（P>0.05），研究组术后呼吸恢复时间、术后睁眼时间均短于对照组，丙泊酚用量少于于对照组，差异均有统计学意义（P<0.05）；研究组麻醉10 min HR、MAP值及术后10 min HR值均高于对照组，差异均有统计学意义（P<0.05）；术后1、3及6 h研究组MMSE评分均高于对照组，差异均有统计学意义（P<0.05）；两组术后胃肠道运动功能比较，差异均无统计学意义（P>0.05）；研究组不良反应发生率（9.68%）与对照组（24.14%）比较，差异无统计学意义（P>0.05）。结论：瑞芬太尼复合丙泊酚麻醉用于腹腔镜结直肠癌根治术患者有助于缩短术后呼吸恢复时间、术后睁眼时间，降低丙泊酚用量，且患者术后认知恢复更快，对血流动力学指标的影响更小，且安全可靠。

【关键词】 瑞芬太尼 丙泊酚 腹腔镜 结直肠癌根治术 血流动力学 肠道运动功能

Effect of Remifentanil Combined with Propofol on Intraoperative Hemodynamics and Postoperative Intestinal Motility in Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer/WANG Qiming， MEI Kaibo， XIONG Guixiang. //Medical Innovation of China， 2024， 21（15）： 0-076

[Abstract] Objective： To observe the effect of Remifentanil combined with Propofol on intraoperative hemodynamics and postoperative intestinal motility in patients undergoing laparoscopic radical resection of colorectal cancer. Method： A retrospective study was conducted among 60 patients with colorectal cancer who underwent laparoscopic radical resection in Shangrao People's Hospital from June 2021 to June 2023. According to different anesthetic methods， the patients were divided into control group （29 patients receiving Fentanyl combined with Propofol anesthesia） and study group （31 patients receiving Remifentanil combined with Propofol anesthesia）. The perioperative indicators， hemodynamics， postoperative cognitive function [mini-mental state examination （MMSE）]， intestinal motility and adverse reactions were compared between the two groups. Result： There was no statistically significant difference in operation time between the two groups （P>0.05）. The postoperative respiratory recovery time and eye opening time of the study group were shorter than those of the control group， and the dosage of Propofol was less than that of the control group， the differences were statistically significant （P<0.05）. Heart rate （HR） and mean arterial pressure （MAP） at 10 minutes after anesthesia and HR at 10 minutes after operation of the study group were significantly higher than those of the control group， the differences were statistically significant （P<0.05）. The MMSE scores of the study group at 1， 3 and 6 h after operation were significantly higher than those of the control group， the differences were statistically significant （P<0.05）. There were no statistically significant differences in postoperative intestinal motility between the two groups （P>0.05）. The incidence rates of adverse reactions in the study group and the control group were 9.68% and 24.14%， without statistically significant difference between groups （P>0.05）. Conclusion： Applying Remifentanil combined with Propofol anesthesia in laparoscopic radical resection of colorectal cancer can help shorten postoperative respiration recovery time and eye opening time， reduce the dosage of Propofol and promote postoperative cognitive recovery， with less influence on hemodynamic indicators. Besides， the anesthetic method is safe and reliable.

[Key words] Remifentanil Propofol Laparoscopy Radical resection of colorectal cancer Hemodynamics Intestinal motility

First-author's address： Anesthesia Department， Shangrao People's Hospital， Shangrao 334000， China

doi：10.3969/j.issn.1674-4985.2024.15.017

结直肠癌的原发部位为直肠或结肠，其与直肠癌有着多种共同特征，大多数结直肠癌是由息肉引起的，部分溃疡性结肠炎也可发展为结肠癌[1-2]。近些年来社会在发展，人们生活节奏发生巨变，结直肠癌发病率直线上升，使得结直肠癌位于三大高发癌症之列[3]。结直肠癌早期症状不明显，部分人群会伴有便血，但一般认为是痔疮、便秘等常规疾病，但一经确诊后患者一般已经步入中晚期[4]。目前手术……