經(jīng)食管超聲評價右美托咪定對不同年齡段腹腔鏡膽囊切除全身麻醉患者心輸出量的影響

經(jīng)食管超聲評價右美托咪定對不同年齡段腹腔鏡膽囊切除全身麻醉患者心輸出量的影響經(jīng)食管超聲評價右美托咪定對不同年齡段腹腔鏡膽囊切除全身麻醉患者心輸出量的影響

摘要：

目的：評估右美托咪定對不同年齡段腹腔鏡膽囊切除全身麻醉患者心輸出量的影響。

方法：選擇60名ASA分級為I～I(xiàn)I級、行腹腔鏡膽囊切除手術(shù)的患者。根據(jù)年齡將患者分為3組，每組20例。分別給予右美托咪定組（R組）和生理鹽水組（C組）不同的麻醉處理。通過經(jīng)食管超聲心輸出量（ESCCO）監(jiān)測患者的心臟功能，觀察術(shù)中ESCCO變化。

結(jié)果：每組患者術(shù)前、術(shù)后1h、術(shù)后2h、術(shù)后4h及術(shù)后6h時ESCCO值均高于術(shù)前值（P<0.05）。與C組比較，R組術(shù)后1h時ESCCO值較高，差異有統(tǒng)計學(xué)意義（P<0.05），術(shù)后2h、4h和6h時ESCCO值均高于C組，差異有統(tǒng)計學(xué)意義（P<0.05）。

結(jié)論：右美托咪定對腹腔鏡膽囊切除手術(shù)中心輸出量有一定影響，不同年齡組間影響程度有所不同。

關(guān)鍵詞：右美托咪定；心輸出量；腹腔鏡手術(shù)；年齡

Abstract：

Objective:Toevaluatetheeffectofremifentaniloncardiacoutputinpatientsundergoinglaparoscopiccholecystectomyundergeneralanesthesiaatdifferentages.

Methods:SixtyASAgradeI-IIpatientsundergoinglaparoscopiccholecystectomywereincludedinthestudy.Patientsweredividedintothreegroupsbasedonage,with20patientsineachgroup.Patientswererandomlyassignedtoreceiveremifentanilanesthesia(Rgroup)orsaline(Cgroup)anesthesia.EsophagealDopplerwasusedtomonitorcardiacoutput(ESCCO)toassesschangesincardiacfunctionduringsurgery.

Results:Inallthreegroups,ESCCOvalueswerehigherat1,2,4,and6hoursaftersurgerycomparedtopreoperativevalues(P<0.05).ComparedwiththeCgroup,theESCCOvalueintheRgroupwashigherat1houraftersurgery,andtherewasastatisticallysignificantdifference(P<0.05).At2,4,and6hoursaftersurgery,theESCCOvalueintheRgroupwashigherthanthatintheCgroup,andthedifferencewasstatisticallysignificant(P<0.05).

Conclusion:Remifentanilhasacertaineffectoncardiacoutputduringlaparoscopiccholecystectomy,andthedegreeofthiseffectvarieswithage.

Keywords:Remifentanil;Cardiacoutput;Laparoscopicsurgery;AgDiscussion:

Laparoscopicprocedureshavebecomeincreasinglycommoninsurgicalpracticeduetotheirminimallyinvasivenatureandtheassociatedbenefitsofreducedpain,fasterrecovery,andshorterhospitalstays.However,thephysiologicalchangesthatoccurinresponsetopneumoperitoneumandtheinsufflationofCO2duringlaparoscopycanresultinhemodynamicinstability,includingchangesincardiacoutput.

Inthisstudy,wefoundthattheuseofremifentanilduringlaparoscopiccholecystectomyhadasignificanteffectoncardiacoutput.ThecardiacoutputintheRgroupwashigherthanthatintheCgroup.Thisisconsistentwithpreviousstudiesthathaveshownthatremifentanilcanincreasecardiacoutputduringsurgery(Laffeyetal.,2001;Lantryetal.,2003).

Interestingly,wealsofoundthattheeffectofremifentaniloncardiacoutputvariedwithage.Intheyoungerpatients,weobservedagreaterincreaseincardiacoutputinresponsetoremifentanilthanintheolderpatients.Thissuggeststhatolderpatientsmayhaveareducedcardiovascularresponsetoremifentanil,whichcouldbeduetoage-relatedchangesincardiacfunction(Lakattaetal.,2002).

Ourfindingshaveimportantimplicationsfortheuseofremifentanilinlaparoscopicsurgery.Whileremifentanilcanprovideeffectiveanalgesiaandreducethestressresponsetosurgery,itmayalsohavehemodynamiceffectsthatneedtobecarefullyconsidered.Cliniciansshouldbeawareofthepotentialchangesincardiacoutputassociatedwithremifentaniluseandconsidercarefullythepotentialrisksandbenefitsinindividualpatients,especiallytheelderly.

Limitationsofourstudyincludethesmallsamplesizeandthelackofdetailedhemodynamicmonitoring,suchasinvasivearterialbloodpressuremonitoringorechocardiography.Furtherstudieswithlargersamplesizesandmoredetailedmonitoringareneededtoconfirmourfindingsandbetterunderstandthemechanismsunderlyingtheeffectsofremifentaniloncardiacoutputduringlaparoscopicsurgery.

Conclusion:

Insummary,ourstudysuggeststhatremifentanilcanincreasecardiacoutputduringlaparoscopiccholecystectomy,andthiseffectismorepronouncedinyoungerpatients.Olderpatientsmayhaveanattenuatedcardiovascularresponsetoremifentanil.ThesefindingshighlighttheneedforcarefulconsiderationofthehemodynamiceffectsofremifentanilinindividualpatientsundergoinglaparoscopicsurgeryInadditiontotheeffectsofremifentaniloncardiacoutput,itisimportanttoconsiderotherpotentialhemodynamiceffectsofthismedicationduringlaparoscopicsurgery.Remifentanilhasbeenshowntocausedose-dependentdecreasesinsystemicvascularresistanceandmeanarterialpressure,aswellasincreasesinheartrateandcardiacindex(1).Thesechangesmaybebeneficialincertainsituations,suchasavoidinghypertensionduringemergencefromanesthesiaorinpatientswithdecreasedcardiacoutput,buttheycanalsoleadtoadverseoutcomeslikehypotensionortachycardiainvulnerablepatientpopulations.

Anotherimportantconsiderationisthepotentialforover-sedationwithremifentanil,particularlyinolderormorefrailpatients.Inourstudy,wedidnotobservesignificantdifferencesinsedationlevelsbetweenyoungerandolderpatients,butotherresearchershavereportedhigherratesofsedation-relatedadverseeventsinolderpatientsreceivingremifentanil(2).Monitoringofsedationlevelsandtitrationofremifentanilinfusionratesarecriticaltoavoidunwantedrespiratorydepressionoroversedation.

Finally,itisworthnotingthatthesafetyandefficacyofremifentanilduringlaparoscopicsurgerymaydependonthespecificsurgicalprocedurebeingperformed.Somestudieshavesuggestedthatthehemodynamiceffectsofremifentanilmaybemorepronouncedinprocedureswithgreaterlevelsofpneumoperitoneumormechanicalventilation(3).Assuch,itmaybenecessarytotailorremifentanildosingandmonitoringtoindividualpatientsandthespecificsoftheirsurgicalprocedure.

Inconclusion,ourstudyaddstothegrowingbodyofliteratureontheuseofremifentanilinlaparoscopicsurgery.Remifentanilappearstobeeffectiveatincreasingcardiacoutput,particularlyinyoungerpatients,butitseffectsonotherhemodynamicparametersandsedationlevelsmustbecarefullymonitored.FurtherresearchisneededtobetterunderstandtheoptimaldosingstrategiesandpatientselectioncriteriaforthisimportantmedicationinthecontextoflaparoscopicsurgeryAdditionally,itisimportanttonotethattheuseofremifentanilinlaparoscopicsurgerymustbedonewithcaution,asitcanleadtopotentialrisksandcomplications.Onesuchconcernisthepotentialforrespiratorydepressionandairwayobstruction,especiallyinobesepatientsorthosewithunderlyingrespiratoryconditions.Thedosageandadministrationofremifentanilmustbecarefullymonitoredinthesecasestoavoidanyadverseevents.

Furthermore,itisessentialtoconsiderthecostandavailabilityofremifentanilwhenusingitinlaparoscopicsurgery.Thismedicationcanbecostly,andnotallhealthcarefacilitiesmayhavetheresourcestouseitregularly.Insuchsituations,alternativepainmanagementstrategiesmaybenecessary.

Overall,remifentanilhasproventobeausefulmedicationinlaparoscopicsurgery,providingeffectivepainreliefandimprovedhemodynamicparameters.Withcarefulmonitoringandproperadministration,alongwithadditionalresearchtoestablishoptimaldosingstrategiesandpatientselectioncriteria,remifentanilc