异丙酚复合芬太尼靶控静脉麻醉在胸腔镜手术中的应用  

The Appliance of Anesthesia With Target-controlled Infusion of Propofol-fentanyl to Thoracoscopic Operation

作　　者：郭立平[1] 彭庆明[1] 李玉成[1] 王忠生 

机构地区：[1]南华大学第一附属医院,湖南衡阳421001 [2]衡阳县人民医院

出　　处：《南华大学学报（医学版）》2005年第1期60-63,共4页Journal of Nanhua University(Medical Edition)

摘　　要：目的　观察异丙酚复合芬太尼静脉靶控输注用于胸腔镜手术麻醉和单肺通气过程中呼吸循环功能的变化及麻醉苏醒情况 ,以评价其实用性和安全性。方法　ASAⅡ～Ⅲ级择期行胸腔镜手术病人 60例 ,随机分为静吸复合麻醉 (C)组、异丙酚芬太尼靶控 (P)组 ,每组 30例。术中连续监测ECG、BP、HR、SPO2 、PETCO2 ,间断采桡动脉血查PaO2 ,并记录术毕停药后病人自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间和离开恢复室时间 ;观察病人拔管后即刻、离开恢复室时、拔管后 1h、3h的意识状态 (OAA S)。结果　 ( 1 )C组术中MAP明显低于术前 ,而P组无显著性变化 ,两组间比较 ,C组低于P组 ,差异有显著性意义 (P <0 .0 5 ) ;( 2 )单肺通气后两组PaO2 均显著下降 ,且C组较P组下降明显 ,但均在正常范围 ;( 3)两组病人术毕自主呼吸恢复时间、呼之睁眼时间、拔管时间差异无显著性意义 ,但P组的定向力恢复时间和离开恢复室 (PACU)时间早于C组 ,P组病人在拔管后即刻、离开恢复室时、拔管后 1h、3h的意识状态OAA S评分高于C组。结论　与常规静吸复合麻醉比较 ,异丙酚复合芬太尼靶控静脉麻醉用于胸腔镜手术麻醉期间呼吸循环维持良好 。Objective To assess the practical and safety of anesthesia with target-controlled infusion (TCI) of propofol-fentanyl by observing the condition of TCI propofol-fentanyl in operation under thoracoscope,and of the functional changes of one-lung ventilation and the anesthesia recovery. Methods 60 ASA physical statusⅡ～Ⅲ patients scheduled for elective VATS were randomly and equally divided into two groups. In group C anesthesia was induced with propofol, fentanyl intravenous injection and maintained with isoflurane inhalation. In group P anesthesia was induced and maintained with TCI propofol-fentanyl. MAP, HR, ECG, SPO 2, P ET CO 2 were monitored during the entire procedures,and blood gas analysis was made before operation, 30 min following two-lung ventilation, 30 min and 60 min following one-lung ventilation in both groups,respectively. The following were recorded and compared between the two groups:(1)the changes in MAP and HR during anesthesia and operation;(2) recovery of spontaneous breathing and orientation after termination of anesthesia;(3)the duration of stay in PACU; (4)OAA/S scores after operation. Results (1)During operation MAP was significantly lower in group C than before operation, and lower than that in group P. (2)PaO 2 decreased significantly during one-lung ventilation in both groups,but there was no significant difference in PaO 2 between the two groups.(3)The duration from termination of anesthetics to fully recovery of spontaneous breathing, eye opening at request and tracheal extubation were similar between the two groups.(4)The stay in PACU and recovery of orientation after termination of anesthesia were significantly shorter in group P than that in group C.(5) The OAA/S score (5=fully conscious,1=deep sleep) at extubation and diacharge from PACU was significantly higher in group P than in group C. Conclusion TCI propofol-fentanyl total intravenous anesthesia in operation under thoracoscope could keep better respiratory circulatory function and could have high qu

关 键 词：异丙酚 哌啶类 靶控输注 静脉内麻醉 胸腔镜手术 

分 类 号：R614.24[医药卫生—麻醉学]