七氟烷与丙泊酚复合瑞芬太尼对老年食管癌根治术后血流动力学水平的影响  

Effects of Sevoflurane and Propofol combined with Remifentanil on hemodynamics in elderly patients with esophageal cancer after radical operation

作　　者：陈元良[1] 徐丽丽[2] 蓝志坚[1] 张磊[1] 

机构地区：[1]金华市中心医院麻醉科,浙江金华321000 [2]浙江中医药大学附属第二医院麻醉科,浙江杭州310005

出　　处：《中华全科医学》2017年第2期198-201,共4页Chinese Journal of General Practice

基　　金：国家自然科学基金(81400929)

摘　　要：目的探讨七氟烷与丙泊酚复合瑞芬太尼对老年食管癌根治术后血流动力学水平的影响。方法将72例择期行食管癌根治术的患者分为2组,每组36例。全部患者采用瑞芬太尼(3 ng/ml)、丙泊酚(3μg/ml)、顺阿曲库铵进行麻醉诱导,观察组采用吸入七氟烷复合靶控输注瑞芬太尼进行麻醉维持;对照组采用靶控输注丙泊酚联合瑞芬太尼进行麻醉维持。于麻醉前(T1)、切皮时(T2)、术毕(T3)、拔管时(T4),对比2组血流动力学(收缩压SBP、舒张压DBP、平均动脉压MAP、心率HR、麻醉深度BIS值)水平变化;采用视觉模拟评分法(VAS)评估患者拔管后疼痛情况;记录患者睁眼时间、拔管时间。记录2组不良反应(恶心呕吐、躁动、寒战、呼吸抑制)发生情况。结果在T2、T3时,2组患者SBP、DBP、MAP、HR、BIS值均显著低于T1时的水平,差异有统计学意义(P<0.05);2组各时间点SBP、DBP、MAP、HR、BIS值对比差异无统计学意义(P>0.05);观察组VAS评分、睁眼时间、拔管时间均显著低于对照组,差异有统计学意义(P<0.05);2组不良反应发生率(11.11%vs.13.89%)对比差异无统计学意义(P>0.05)。结论七氟烷与丙泊酚复合瑞芬太尼在老年食管癌根治术中的麻醉效果相当,七氟烷复合瑞芬太尼的苏醒时间更短。Objective To investigate the effects of Sevoflurane and Propofol combined with Remifentanil on hemodynamics in elderly patients with esophageal cancer after radical operation. Methods A total of 72 cases of esophageal cancer patients in our hospital were divided into two groups with 36 cases in each group. All patients were induced by Remifentanil（ 3 ng / ml）,Propofol（ 3 μg / ml） and cis-ammonium bromide for anesthesia induction. The patients in the observation group were given seven Sevoflurane combined with target controlled infusion of Remifentanil for anesthesia maintenance,while the patients in control group were given target controlled infusion of Propofol combined with Remifentanil for anesthesia maintenance. Before anesthesia（ T1）,skin incision（ T2） and the end of operation（ T3）,extubation（ T4）,the hemodynamics index of two groups of patients were compared,including systolic blood pressure（ SBP）,diastolic blood pressure（ DBP）,mean arterial pressure（ MAP）,heart rate（ HR）,the depth of anesthesia（ BIS value）. The pain of patients after extubation was assessed by visual analogue scale（ VAS）. The awaking time and time to extubation of patients in two groups were recorded. The incidence of adverse reactions of both groups was recorded,including nausea and vomiting,restlessness and shivering and respiratory depression. Results At T2 and T3,SBP,DBP,MAP,HR,BIS values of patients in both groups were significantly lower than in the level of T1,the difference was statistically significant（ P 〈0. 05）. At each time point,SBP,DBP,MAP,HR,BIS value between the two groups were compared,the difference was not statistically significant（ P 〉0. 05）. The VAS score,awaking time and time to extubation of the observation group were significantly lower than those of the control group,the difference was statistically significant（ P 〈0. 05）. Adverse reaction rates（ 11. 11% vs.13. 89%） were compared between the two groups,and the difference was not statistically si

关 键 词：七氟烷 丙泊酚 瑞芬太尼 食管癌根治术 血流动力学 

分 类 号：R735.1[医药卫生—肿瘤] R614.2[医药卫生—临床医学]