饱和状态后低氧流量七氟醚联合丙泊酚用于老年腹部肿瘤手术的临床观察  

Clinical Observation of Hypoxia Flow Sevoflurane Combined with Propofol for Elderly Abdominal Tumor Surgery in Saturation

作　　者：万向学 郑秋艳[1] 郑智文[1] WAN Xiangxue;ZHENG Qiuyan;ZHENG Zhiwen(Tangshan People’s Hospital,Hebei Tangshan 063000,China)

机构地区：[1]唐山市人民医院,河北唐山063000

出　　处：《中国药房》2016年第24期3374-3376,共3页China Pharmacy

摘　　要：目的：观察饱和状态后低氧流量七氟醚联合丙泊酚用于老年腹部肿瘤手术的麻醉效果和安全性。方法：128例择期接受全身麻醉下腹部肿瘤外科手术的老年患者随机分为观察组（64例）和对照组（64例）。麻醉诱导气管插管后氧流量调至6L/min，七氟醚挥发罐调至2％，吸入10min后，观察组患者将氧流量调至0.5L/min，对照组患者调至1.5L/min，两组均给予丙泊酚0.5～1.0mg/L，全程靶控输注，持续静脉泵注瑞芬太尼，根据术中肌肉松弛情况间断推注维库溴铵1～2mg/次。观察两组患者插管后10min（T0）、术中1h（T1）、术中2h（T2）、术毕（T3）时的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、中心静脉压（CVP）、吸入氧浓度（FiO2）、呼气末二氧化碳分压[p（CO2）]；记录两组患者七氟醚使用剂量，患者苏醒时间、苏醒期躁动情况及不良反应发生情况；记录手术前后患者的血尿素氮（BUN）、血肌酐（Cr）、丙氨酸转氨酶（ALT）水平；评价术后早期认知功能障碍发生情况。结果：两组患者各时间点HR、MAP、SpO2、CVP、FiO2、p（CO2）比较，差异均无统计学意义（P＞0.05）。观察组患者七氟醚使用剂量、苏醒时间、术后3h及6h认知功能障碍发生率、不良反应发生率均显著低于对照组，差异均有统计学意义（P＜0.05）。两组患者苏醒期躁动发生例数、术后1d、3d认知功能障碍发生率比较，差异均无统计学意义（P＞0.05）。术后，两组患者ALT水平均显著高于同组术前，差异有统计学意义（P＜0.05），但组间比较差异无统计学意义（P＞0.05）。两组患者术前ALT及于术前后BUN、Cr比较差异均无统计学意义（P＞0.05）。结论：饱和状态后低氧流量七氟醚联合丙泊酚用于老年腹部肿瘤手术的麻醉效果显著，血流动力学稳定，能减少七氟醚用量，缩短苏醒时间，降低术后认�OBJECTIVE:To observe the anesthesia effect and safety of hypoxia flow sevoflurane combined with propofol for elderlyabdominal tumor surgery in saturation. METHODS:128 elderly patients took abdominal tumor surgery under general anesthesiawere randomly divided into observation group(64 cases)and control group(64 cases). After routine anesthetic induction,theoxygen flow was adjusted to 6 L/min,vaporizer was adjusted to 2%,10 minutes after inhalation,the observation group was adjustedto 0.5 L/min,and control group was 1.5 L/min,all received 0.5 mg/L propofol by target-controlled infusion,continuous infusionof remifentanil,intermittent bolus injection of vecuronium 1-2 mg/times based on the intraoperative muscle relaxation. Heartrate(HR),mean arterial pressure(MAP),oxygen saturation(SpO2),central venous pressure(CVP),inspired oxygen concentration(FiO2),end-tidal carbon dioxide partial pressure [p(CO2)] in 10 min(T0),intraoperative 1 h(T1),intraoperative 2 h(T2),end of surgery(T3)in 2 groups were observed;sevoflurane dosage,recovery time,restlessness,and blood urea nitrogen(BUN),serum creatinine(Cr),alanine aminotransferase(ALT)levels,incidence of early cognitive dysfunction before and after surgeryand the incidence of adverse reactions in 2 groups were recorded. RESULTS:There were no significant differences in the HR,MAP,SpO2,CVP,FiO2 and p(CO2)in 2 groups at different time points(P>0.05). The sevoflurane dosage,recovery time,theincidences of cognitive dysfunction postoperative 3 h and 6 h and adverse reactions in observation group were significantly lowerthan control group,the differences were statistically significant(P<0.05). And there were no significant differences in the caseswith restlessness and incidence of cognitive dysfunction postoperative 1 d and 3 d(P>0.05). After surgery,ALT levels in 2 groupswere significantly higher than before,the difference was statistically significant(P<0.05),but there was no significant differencebetween 2 groups(P>0.05). There were no significant differences in preoperative ALT

关 键 词：低氧流量麻醉 七氟醚 丙泊酚 腹部肿瘤 认知功能障碍 

分 类 号：R614.27[医药卫生—麻醉学]