Effects of sevoflurane combined with remifentanil on analgesia,sleep,and inflammation in patients undergoing thoracoscopic lobectomy
Objective To evaluate the safety and efficacy of sevoflurane combined with remifentanil in patients undergoing thoracoscopic lobectomy.Methods This was a randomized controlled trial.A total of 86 patients who underwent thoracoscopic lobectomy in Shenmu Hospital from January 2021 to October 2023 were included and were divided into two groups according to the random number table method.One group received conventional analgesic drugs(sevoflurane group),the other group received sevoflurane combined with remifentanil(combined group),with 43 cases in each group.In the sevoflurane group,there were 23 males and 20 females,aged(28.14±4.65)years.In the combined group,there were 25 males and 17 females,aged(29.57±4.64)years.The sevoflurane group received sevoflurane inhalation anesthesia,and the concentration was maintained at 1.2-2.0 MAC(minimum alveolar concentration)to ensure sufficient depth of anesthesia.Anesthesia induction in the combined group was the same as that in the sevoflurane group.Sevoflurane inhalation anesthesia was used for maintenance anesthesia,but the concentration was maintained at 0.7-1.5 MAC,which was slightly lower than that in the sevoflurane group.Analgesia was maintained by adding remifentanil on the basis of sevoflurane to improve the analgesia effect,and remifentanil was continuously transfused at a rate of 0.2-0.5 μg/(kg·h).The differences in analgesic effects[rescue analgesia rate and Visual Analogue Scale(VAS)score],sleep quality indicators[arousal index(AI),sleep efficiency index(SEI),and proportion of rapid eye movement sleep time(REM)],inflammatory indexes[interleukin(IL)-1,IL-6,IL-10,C-reactive protein(CRP),and tumor necrosis factor α(TNF-α)],and adverse reactions were compared between the two groups.Independent sample t test and x2 test were used.Results Compared with those in the sevoflurane group,the rescue analgesia rate was lower in the combined group[11.63％(5/43)vs.30.23％(13/43)];1,24,and 48 h after surgery,the VAS score of the combined group was lower[(5.16±1.52)points vs.(6.53±1.82)points,(2.69±1.11)points vs.(3.41±1.31)points,(1.25±0.66)points vs.(1.57±0.62)points],with statistically significant differences(all P＜0.05).The Al and SEI at night in the combined group were lower than those in the sevoflurane group 1 d after surgery(both P＜0.05).The levels of IL-6,IL-10,IL-1β,TNF-α,and CRP in the combined group were lower than those in the sevoflurane group 1 d after surgery,with statistically significant differences(all P＜0.05).The total incidence of adverse reactions in the combined group was lower than that in the sevoflurane group[4.65％(2/43)vs.18.60％(8/43)],with a statistically significant difference(x2=4.074,P=0.044).Conclusions Sevoflurane combined with remifentanil in patients undergoing thoracoscopic lobectomy can significantly improve the analgesic effect and sleep quality while reducing the inflammatory response.This analgesic scheme is safe and effective.
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