| Objective: This article aims to investigate the effects of induction and continuous intravenous infusion of alfentanil and remifentanil,respectively,on the perioperative hemodynamics,as well as the recovery time during recovery and postoperative pain scores in gynecological laparoscopic surgery.Comparison of nausea and vomiting.Methods: A total of 60 patients who underwent gynecological laparoscopic surgery in the Affiliated Hospital of Qing Hai University from December 2020 to November 2021 were selected.All patients who met the inclusion and exclusion criteria were randomly divided into two groups,with 30 cases in each group,namely alfenta Nitrile group(AF group)and remifentanil group(RF group).The AF group was induced by alfentanil 30 μg/kg,and the RF group was induced by remifentanil 1 μg/kg,The sedation in the AF group and the RF group was maintained by intravenous micropump infusion of propofol at 4-7 mg/(kg·h),the analgesia in the AF group was with alfentanil 1-1.5 μg/(kg·min),and the RF group was treated with alfentanil at 1-1.5μg/(kg·min).Fentanyl 0.3-0.5μg/(kg·min),the anesthesiologist sets the initial pump speed of the two opioids according to the patient’s nutritional status and body weight,and adjusts up and down according to the depth of anesthesia and intraoperative blood pressure and heart rate provided by the BIS value.Adjust until the end of the procedure to stop pumping the drug.The type of operation,operation duration,and basic vital signs at five different time points were recorded: T0 after entering the room,T1 after induction of anesthesia,T2 immediately after tracheal intubation,T3 immediately after skin incision to establish pneumoperitoneum,and T4 immediately after extubation.Systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate at each moment.The patient’s eye opening time T5,command action recovery time T6,spontaneous breathing recovery time T7,and extubation time T8 were recorded.Visual analog pain score(VAS score)and overall comfort score(BCS score)at 1 hour,2 hours,6 hours,and 24 hours after operation,and the occurrence of postoperative nausea and vomiting.Results: The data of the two groups were analyzed.There was no significant difference in general data(age,ASA grade,BMI)between the two groups(P>0.05),and there was no significant difference in operation type and operation duration between the two groups(P>0.05).There was significant difference between the two groups in SBP at T1 and T4(P<0.05),DBP and map at T1,T2 and T4(P<0.05),HR at T1 and T4(P<0.05).The trend fluctuation of SBP,DBP,map and HR in AF group was more stable than that in RF group at five times.The time of T5,T6,T7 and T8 in AF group was significantly longer than that in RF group(P<0.05).At 1H,2h and 3h after operation,the VAS score of AF group was lower than that of RF group(P<0.05),and there was no significant difference between the two groups at 24 h.The BCS scores of AF group were higher than RF group at 1H,2h and 3h after operation(P<0.05).There was no significant difference between the two groups at 24 h.The incidence of PONV in RF group(40%)was significantly higher than that in AF group(16.7%).Conclusion: Both alfentanil and remifentanil can be safely and effectively used in gynecological laparoscopic surgery,but alfentanil seems to have more advantages in providing stable hemodynamics,reducing the early postoperative pain score and reducing the incidence of postoperative nausea and vomiting.Remifentanil showed faster recovery time during perioperative recovery. |
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