氟比洛芬酯联合盐酸舒芬太尼处理腹腔镜胆囊切除术患者镇痛效果研究*

doi:10.3969/j.issn.1672-5069.2025.06.035

摘要/Abstract

摘要： 目的评估盐酸舒芬太尼与氟比洛芬酯联合应用在腹腔镜胆囊切除术(LC)患者的镇痛效果。方法 2022年4月～2024年11月我院收治的胆囊结石患者104例,均接受LC手术,在麻醉时,被随机分为对照组52例,给予丙泊酚联合盐酸舒芬太尼麻醉,和联合组52例,采用丙泊酚联合氟比洛芬酯和盐酸舒芬太尼麻醉。使用心电监护仪监测麻醉诱导前(T0)、意识消失即刻(T1)、手术切皮即刻(T2)、拔管即刻(T3)和拔管后 10 min(T4)心率(HR)和平均动脉压(MAP);采用视觉模拟评分法(VAS)评估镇痛效果;采用ELISA法检测血清白细胞介素-1β (IL-1β)、IL-6和IL-10水平。结果在T1、T2、T3和T4时,联合组HR分别为(77.2±3.9)次/min、(79.1±3.6)次/min、(77.9±3.3)次/min和(76.1±4.1)次/min,均显著低于对照组【分别为(82.7±2.7)次/min、(84.5±3.0)次/min、(80.4±2.9)次/min和(78.9±2.6)次/min,P＜0.05】,MAP分别为(75.4±3.8)mmHg、(77.2±3.3)mmHg、(80.2±3.6)mmHg和(85.4±4.6)mmHg,均显著低于对照组【分别为(79.5±3.7)mmHg、(84.8±3.4)mmHg、(87.2±3.1)mmHg和(88.1±3.5)mmHg,P＜0.05】;在术后2 h、6 h和12 h,联合组VAS评分分别为(1.9±0.5)分、(2.1±0.7)分和(2.9±0.8)分,均显著低于对照组【分别为(2.2±0.5)分、(3.1±0.9)分和(3.9±1.1)分,P<0.05】;在术后恢复过程中,联合组自主呼吸恢复时间为(8.6±2.5)min,苏醒时间为(9.1±2.9)min,均显著短于对照组【分别为(10.9±2.9)min和(12.7±3.0)min,P<0.05】;在术后12 h,联合组血清IL-1β和IL-6水平分别为(43.5±8.0)pg/mL和(107.1±18.6)pg/mL,均显著低于对照组【分别为(49.1±7.5)pg/mL和(126.3±14.6)pg/mL,P＜0.05】。结论在施行LC手术过程中,应用盐酸舒芬太尼联合氟比洛芬酯镇痛效果好,对血流动力学的影响小,术后恢复快,可能与抑制了细胞因子分泌有关。

关键词: 胆囊结石, 腹腔镜胆囊切除术, 舒芬太尼, 氟比洛芬酯, 镇痛

Abstract: Objective The aim of this study was to evaluate analgesic effect of fluorobiphenyl ester and fentanyl hydrochloride combination in patients with cholecystolithiasis during laparoscopic cholecystectomy (LC). Methods A total of 104 patients with cholecystolithiasis were encountered in our hospital between April 2022 and November 2024, and all underwent LC. For analgesia, the patients were assigned to receive propofol and sufentanil hydrochloride in 52 cases in control group, or to receive propofol, flurbiprofen axetil and sufentanil hydrochloride combination in other 52 cases in the observation group. Hemodynamic parameters, e.g., heart rate (HR) and mean arterial pressure (MAP) were monitored before anesthesia induction (T0), after loss of consciousness (T1), after skin incision (T2), after extubation (T3) and 10 minutes post-extubation (T4). Postoperative pain was assessed by using the visual analog scale (VAS) at 2 h, 6 h, 12 h and 24 h. Recovery times for spontaneous breathing and awakening were recorded. Serum levels of interleukin-1β (IL-1β), IL-6 and IL-10 were measured by ELISA. Results In combination group, it showed significantly lower HRs and MAPs at T1 to T4 compared to in the control group (P<0.05); recovery times for spontaneous breathing [(8.6±2.5) min] and awakening [(9.1±2.9) min] were much shorter in the combination group than in the control group [(10.9±2.9) min and (12.7±3.0) min, respectively, P<0.05]; postoperative VAS scores at 2 h, 6 h and 12 h were also much lower in the combination group [(1.9±0.5), (2.1±0.7) and (2.9±0.8) points] compared to in the control group [(2.2±0.5), (3.1±0.9) and (3.9±1.1) points, P<0.05]; at 12 hours postoperatively, serum levels of IL-1β and IL-6 in the combination group were (43.5±8.0)pg/mL and (107.1±18.6)pg/mL, both significantly lower than [(49.1±7.5)pg/mL and (126.3±14.6)pg/mL, respectively, P＜0.05] in the control group. Conclusion The combination of sufentanil hydrochloride and flurbiprofen axetil provides an effective postoperative analgesia in patients with cholecystolithiasis during LC, with relatively less impact on hemodynamic parameters and quick consciousness, which might be related to less activation of cytokine reaction.

Key words: Cholecystolithiasis, Laparoscopic cholecystectomy, Sufentanil hydrochloride, Flurbiprofen axetil, Analgesia

崔丹, 姜子怡, 石书豪, 崔佳丽. 氟比洛芬酯联合盐酸舒芬太尼处理腹腔镜胆囊切除术患者镇痛效果研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 938-941.

Cui Dan, Jiang Ziyi, Shi Shuhao, et al. Analgesic effect of fluorobiphenyl ester and fentanyl hydrochloride combination in patients with cholecystolithiasis during laparoscopic cholecystectomy[J]. Journal of Practical Hepatology, 2025, 28(6): 938-941.

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氟比洛芬酯联合盐酸舒芬太尼处理腹腔镜胆囊切除术患者镇痛效果研究^*

Analgesic effect of fluorobiphenyl ester and fentanyl hydrochloride combination in patients with cholecystolithiasis during laparoscopic cholecystectomy

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