| Objective: To explore the effects of multi target-controlled infusion sufentanil and low-concentration target-controlled infusion sufentanil on perioperative analgesia,stress response and postoperative recovery quality in patients with general anesthesia.To provide the basis for the rational use of perioperative analgesics and the rapid,safe and painless recovery of anesthesia and surgery.Methods: This study is a prospective randomized controlled clinical trial.Patients who underwent elective gastrointestinal tumor surgery between December 2020 and December 2021 were selected.124 patients who met the inclusion criteria were randomly assigned to the control group with target-controlled infusion of sufentanil at common concentrations(group A,n=42),and the study group included target-controlled infusion of sufentanil with multiple target-controlled concentrations(Group B,n=42)and target-controlled infusion low-concentration sufentanil group(group C,n=40).Intraoperative closed-loop target-controlled propofol maintained BIS40-60,and patients in group A continued to maintain a single target-controlled concentration of 0.4 ng/ml during the operation;patients in group B were stimulated with different intensities during the operation(including tracheal intubation,preparation after intubation)stage,skin incision and pneumoperitoneum establishment,abdominal exploration,auxiliary small incision and tumor resection,suture skin and spontaneous breathing)continuously adjust the target-controlled concentration of sufentanil,which is 0.4ng/ml,0.25ng/ml,0.5ng /ml(keep 10 minutes),0.3ng/ml,0.5ng/ml,0.25ng/ml;patients in group C continued to maintain a single target control concentration of 0.25ng/ml during the operation.Main outcome measures: Radial artery blood was drawn at several moments after lying supine for 5 minutes(T1),after tracheal intubation(T2),after pneumoperitoneum(T3),after tumor resection(T4),and 1 hour after recovery from anesthesia(T5).And record the values of norepinephrine(NE),epinephrine(E),dopamine(DA),interleukin-6(IL-6),cortisol(Cor),blood glucose(Glu).Secondary observation indicators included intraoperative hemodynamic changes,incidence of cardiovascular events,postoperative recovery time and recovery quality,postoperative NRS score,comparison of use of analgesic pumps and analgesics,postoperative recovery and complications,and comparison of anesthetic drug consumption.situation etc.Results: 42 cases in group A,42 cases in group B and 40 cases in group C were included in the final statistical analysis.(1)General information: age,sex ratio,ASA classification,height,weight,BMI,operation and anesthesia time,proportion of surgical site,intraoperative urine volume,blood loss,infusion volume,preoperative hemoglobin,platelets,and white blood cells of the three groups of patients,the difference among the three groups was not statistically significant(P<0.05).(2)Primary outcome measure: There was no significant difference in NE,E,DA,IL-6,Cor and Glu among the three groups at T1time(P>0.05).E and IL-6 in group C at T2-T5 time points were significantly higher than those in groups A and B,and the difference was statistically significant(P<0.05).The NE,Cor,and Glu of group C at T4 and T5 were significantly higher than those of group A and group B,and the difference was statistically significant(P<0.05).The DA at time points T3 and T5 in group C was significantly higher than that in groups A and B,and the DA at time point T4 in group C was significantly higher than that in group B;the DA at time point T4 in group B was significantly higher than that in group A,and the differences were statistically significant(P< 0.05).The changes of NE,E,DA,IL-6,Cor,and Glu were different in the three groups at different times,but the increase in group C was the largest,and the difference was statistically significant(P<0.05).(3)Intraoperative hemodynamic changes and incidence of cardiovascular events: the MAP and HR levels of group C at each time point(except T1 time)were significantly higher than those of groups A and B,and the difference was statistically significant(P<0.05).The incidence of intraoperative hypertension in group C was significantly higher than that in groups A and B,and the difference was statistically significant(P<0.001);the incidence of intraoperative hypotension in group A was significantly higher than that in groups B and C,and the difference was statistically significant(P<0.005);the incidence of intraoperative tachycardia in group C was significantly higher than that in group B,and the difference was statistically significant(P<0.005);there was no significant difference in the incidence of sinus bradycardia among the three groups(P>0.05).(4)Postoperative recovery time and recovery quality: the postoperative eye opening time in group B was significantly shorter than that in groups A and C,and the difference was statistically significant(P<0.01);the postoperative extubation time in group B was significantly shorter than that in group A,the difference was statistically significant(P<0.01);the incidence of postoperative agitation in group C was significantly higher than that in groups A and B,and the difference was statistically significant(P<0.001);the incidence of nausea and vomiting,respiratory amnesia,and chills were three There was no significant difference between groups(P>0.05).(5)Postoperative NRS score and the use of analgesic pumps and analgesics: The NRS level of group C was significantly higher than that of A and B at six important time points:5 minutes after extubation,2h after surgery,8h after surgery,24 h after surgery,48 h during surgery,and72 h after surgery;the NRS level of group A was significantly higher than that of group B at five important time points: 2h after surgery,8h after surgery,24 h after surgery,48 h during surgery,and 72 h after surgery,and the difference was statistically significant(P<0.05).The amount of analgesic pump used at 24 hours after operation,the number of analgesic pump pressing times at 24 hours after operation,and the number of people who urgently added other analgesics at 24 hours after operation in group C were significantly higher than those in groups A and B,and the differences were statistically significant(P< 0.001).(6)Postoperative complications occurred: There was no significant difference in the incidence of nausea and vomiting,dizziness,bleeding,anastomotic leakage,infection,fever,and urinary retention among the three groups during hospitalization(P>0.05).(7)Comparison of the dosage of anesthetics: The amount of sufentanil used in the 3 hours of operation and the total amount of sufentanil used during surgery in group A were different among the three groups,and the difference was statistically significant(P<0.001).the amount of sufentanil used in group A for 3 hours during operation and the total amount of sufentanil used during surgery significantly higher than those in groups B and C,and the difference was statistically significant(P<0.05).The amount of sufentanil used at 3 hours and the total amount of sufentanil used during surgery were significantly higher than those in group C,and the differences were statistically significant(P<0.05).The group was significantly larger than that of groups A and B,and the difference was statistically significant(P<0.001).Conclusion: Through this study,we have confirmed that the continuous regulation of the target-controlled concentration of sufentanil according to the surgical characteristics and intraoperative stimulation intensity can effectively control the perioperative stress response of patients with general anesthesia,improve the quality of patients’ postoperative recovery,and not affect the patients.Postoperative recovery,optimization of perioperative analgesia and reduction of opioid use,low-concentration target-controlled infusion of sufentanil cannot effectively control perioperative stress response in patients undergoing gastrointestinal tumor surgery,and patients undergoing surgery Post-wake quality is poor. |
PDF Full Text Request