Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, Jiangsu, China.
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, Jiangsu, China.
J Clin Anesth. 2021 Oct;73:110374. doi: 10.1016/j.jclinane.2021.110374. Epub 2021 Jun 2.
To investigate the effect of propofol-based total intravenous anesthesia (TIVA) or sevoflurane-based inhalation anesthesia on postoperative quality of recovery in patients undergoing total laparoscopic hysterectomy.
A prospective randomized controlled trial.
An operating room, a postoperative recovery area, and a hospital ward.
A total of 102 female patients scheduled for elective total laparoscopic hysterectomy were randomly divided into two groups: the propofol group (group P) or sevoflurane group (group S).
Anesthesia in group P was induced by propofol, fentanyl and rocuronium, and maintained by intravenous infusion of propofol and remifentanil. Anesthesia in group S was induced by a tidal volume inhalation technique with sevoflurane and rocuronium and maintained with sevoflurane and remifentanil. Patients in group P did not receive any volatile drugs.
Quality of Recovery-40 (QoR-40), Pittsburgh Sleep Quality Index (PSQI) and Numerical Rating Scale (NRS) scores were assessed at 8, 24, 48, 72 h, 7 days and 30 days after surgery. Intraoperative hemodynamics, postoperative inflammatory indicators and adverse reactions were also recorded.
The QoR-40 score and its 5 dimensions were similar in the two groups at each point in time (P > 0.05). Group S had less consumption of remifentanil (P < 0.001) but increased use of phenylephrine (P = 0.001) intraoperatively. PSQI scores were also comparable between groups at each point in time (P > 0.05). NRS scores at 72 h (P = 0.023) and 7 days (P = 0.017) after surgery, postoperative NLR (P = 0.024) and hs-CRP (P = 0.042), and the incidence of abdominal distension (P = 0.017) were significantly lower in group P than in group S. Multiple linear regression analyses demonstrated that duration of pneumoperitoneum and sleep quality were associated with postoperative recovery.
The choice of intravenous or inhalation maintenance anesthesia did not affect overall postoperative recovery as measured by the QoR-40 in patients undergoing total laparoscopic hysterectomy. Reducing the duration of pneumoperitoneum and improving sleep quality were conducive to postoperative recovery.
探讨丙泊酚全凭静脉麻醉（TIVA）或七氟醚吸入麻醉对腹腔镜全子宫切除术患者术后恢复质量的影响。
前瞻性随机对照试验。
手术室、恢复区和病房。
102 名择期行腹腔镜全子宫切除术的女性患者，随机分为两组：丙泊酚组（P 组）或七氟醚组（S 组）。
P 组麻醉诱导用丙泊酚、芬太尼和罗库溴铵，静脉输注丙泊酚和瑞芬太尼维持麻醉。S 组麻醉诱导采用七氟醚潮气量吸入技术和罗库溴铵，七氟醚和瑞芬太尼维持麻醉。P 组患者不使用任何挥发性药物。
术后 8、24、48、72 小时、7 天和 30 天，采用质量恢复量表 40 项（QoR-40）、匹兹堡睡眠质量指数（PSQI）和数字评分量表（NRS）评分进行评估。还记录了术中血流动力学、术后炎症指标和不良反应。
两组患者在各个时间点的 QoR-40 评分及其 5 个维度均相似（P>0.05）。S 组术中瑞芬太尼用量减少（P<0.001），但苯肾上腺素用量增加（P=0.001）。两组患者在各个时间点的 PSQI 评分也相似（P>0.05）。术后 72 小时（P=0.023）和 7 天（P=0.017）NRS 评分、术后 NLR（P=0.024）和 hs-CRP（P=0.042）、腹胀发生率（P=0.017）均显著低于 S 组。多线性回归分析表明，气腹时间和睡眠质量与术后恢复有关。
在腹腔镜全子宫切除术患者中，选择静脉或吸入维持麻醉并不影响 QoR-40 评估的整体术后恢复。减少气腹时间和改善睡眠质量有助于术后恢复。
