腹腔镜下食管裂孔疝修补术中吸入与静脉麻醉维持方式的比较  

Comparison of the maintenance methods of inhalation and intravenous anesthesia during laparoscopic hiatus hernia repair

作　　者：王效德[1] 潘阳阳 刘晓勇 乔南南 徐桂萍[1] Wang Xiaode;Pan Yangyang;Liu Xiaoyong;Qiao Nannan;Xu Guiping(Department of Anesthesiology,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Xinjiang Medical University,Xinjiang Uygur Autonomous Region,Urumqi,830001,China)

机构地区：[1]新疆维吾尔自治区人民医院麻醉科,乌鲁木齐830000 [2]新疆医科大学研究生学院,乌鲁木齐830000

出　　处：《中华胃食管反流病电子杂志》2018年第4期172-175,共4页Chinese Journal Of Gastroesophageal Reflux Disease(Electronic Edition)

摘　　要：目的探讨全凭静脉与全凭吸入2种麻醉维持方式那种更适合在腹腔镜下食管裂孔疝修补手术中应用。方法回顾性分析2015年2月至2018年2月,新疆自治区人民医院133例患者的病历资料,根据麻醉的维持方法分为2组:七氟醚组(Sev组)(51例)和全凭静脉麻醉组(TIVA组)(82例)。比较2组术中6个时间点(T1:麻醉诱导前;T2:麻醉诱导后;T3:手术开始后30 min;T4:手术开始后60 min;T5:手术开始后90 min;T6:送入PACU时)的心率(HR)和平均动脉血压(MAP),术中及术后不良反应,术后清醒时间、PACU停留时间、排气时间,术后在麻醉复苏室(PACU)中地佐辛用量,术后5个时间点(苏醒时、在PACU、术后8、12、24 h)的VAS评分。结果 TIVA组在术中及术后记录的每个时间点上MAP及HR均明显低于Sev组,差异有统计学意义(P<0.05);2组清醒时间比较,差异无统计学意义(P>0.05);Sev组术中不良事件发生率及术后恶心呕吐(PONV)的发生率均显著高于TIVA组,且PACU停留时间及排气时间更长,术后5个时间点VAS评分更高,地佐辛用量更多,差异均有统计学意义(P<0.05)。结论在腹腔镜下食管裂孔疝修补术中静脉麻醉维持较吸入麻醉维持是一种较好的麻醉维持方法。Objective To investigate the use of two kinds of anaesthesia maintenance methods,namely total venous and total inhalation,which are more suitable for laparoscopic repair of esophageal hiatal hernia.Methods The medical records of 133 patients were retrospectively analyzed and divided into two groups according to the maintenance of anesthesia:sevoflurane group(Sev group)(n=51)and total intravenous anesthesia group(TIVA group)(n=82).Comparing the 6 intraoperative time points(T1:before induction of anesthesia,T2:after induction of anesthesia,T3:30 minutes after surgery,T4:60 minutes after surgery,T5:90 minutes after surgery,T6:when PACU is delivered)heart rate(HR)and mean arterial blood pressure(MAP),intraoperative and postoperative adverse reactions,postoperative awake time,PACU retention time,venting time,postoperative dose of dizocine in the anesthesia Postanesthesia care unit(PACU),The VAS scores at the last 5 time points(wake-up,at the PACU,8 hours postoperatively,12 hours postoperatively,24 hours postoperatively).Results The MAP and HR were significantly lower in the TIVA group than in the Sev group at each time point during and after surgery(P<0.05).There was no significant difference in awake time between the two groups(P>0.05),but the incidence of adverse events and postoperative nausea and vomiting(PONV)were significantly higher in the Sev group than in the TIVA group,and the PACU stay and exhaust time were longer.The VAS score was higher at 5 postoperative days,and the dose of dizocine was more(P<0.05).Conclusion It is better to maintain the intravenous anesthesia during laparoscopic repair of esophageal hiatus than to maintain anesthesia.

关 键 词：疝 食管裂孔 麻醉维持 全凭静脉麻醉 麻醉 吸入 

分 类 号：R614[医药卫生—麻醉学]