七氟醚联合丙泊酚静-吸复合麻醉用于原发性肝癌根治术治疗经验介绍  

Different dosage of sevoflurane and propofol combination venous-inhalation anesthesia in patients with primary liver cancer undergoing radical hepatectomy

作　　者：樊顺克[1] 王贵罗[1] 伊晓燕 Fan Shunke;Wang Guiluo;Yi Xiaoyan(Department of Anesthesiology,Second People's Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]河南省南阳市第二人民医院麻醉科,473000 [2]河南科技大学第一附属医院肿瘤科

出　　处：《实用肝脏病杂志》2022年第5期702-705,共4页Journal of Practical Hepatology

基　　金：河南省医学科技攻关计划项目(编号:2018020992)。

摘　　要：目的探讨不同剂量七氟醚复合丙泊酚静-吸复合麻醉用于原发性肝癌(PLC)根治术的价值。方法2019年11月~2021年11月我院诊治的110例PLC患者,均接受肝叶切除术。在麻醉时,患者被分为A组(n=54)和B组(n=56),A组以0.5肺泡最小有效浓度(MAC)七氟醚复合丙泊酚静-吸复合麻醉,B组以1.0 MAC七氟醚复合丙泊酚静-吸复合麻醉。进行Ramsay镇静、Aldrete评分和简易精神状态检查量表(MMSE)评分,术中监测心律(HR)、平均动脉压(MAP)和血氧饱和度(SpO_(2))。结果在拔管后即刻,B组Ramsay镇静评分为(4.2±0.5)分,显著高于A组【(3.7±0.4)分,P<0.05】,在拔管后15 min和30 min,两组Ramsay评分和Aldrete评分无显著性差异(P>0.05);在术后6 h、24 h和72 h时,B组MMSE评分分别为(25.7±2.8)分、(27.6±1.4)分和(28.4±1.1)分,均显著高于A组【分别为(22.2±3.6)分、(25.4±2.2)分和(27.8±1.2)分,P<0.05】;术中B组HR为(79.5±11.6)次/min,显著快于A组【(74.1±12.4)次/min,P<0.05】,但两组麻醉诱导前和术后6 h时HR比较无显著性差异(P>0.05),两组围术期MAP和SpO_(2)比较无显著性差异(P>0.05);B组不良反应发生率为23.2%,显著高于A组的7.4%(P<0.05)。结论七氟醚复合丙泊酚静-吸复合麻醉应用于PLC患者根治性手术具有较好的麻醉效果。相对于小剂量的七氟醚,应用大剂量的七氟醚可获得更好的术后苏醒质量,更有利于术后神志的恢复,但也会出现不良反应增多的现象。因此,在选择七氟醚药物浓度时,应当及时评估患者麻醉风险,慎重作出决定。Objective The aim of this study was to investigate different dosage of sevoflurane and propofol combination venous-inhalation anesthesia in patients with primary liver cancer(PLC)undergoing radical hepatectomy.Methods A total of 110 patients with PLC were recruited in our hospital between November 2019 and November 2021,and all underwent radical hepatectomy.During anesthesia,the patients were divided into group A(n=54)and group B(n=56),receiving 0.5 minimum alveolar concentration(MAC)or 1.0 MAC sevoflurane and propofol combination intravenous-inhalation anesthesia.The Ramsay sedation,Aldrete scores and mini-mental state examination(MMSE)scores were evaluated.The heart rhythm(HR),mean arterial pressure(MAP)and peripheral oxygen saturation(SpO_(2))were recorded.Results The Ramsay sedation scores in group B immediately after extubation was(4.2±0.5),significantly higher than[(3.7±0.4),P<0.05]in group A,while 5 minutes and 30 minutes after extubation,there were no significant differences respect to Ramsay and Aldrete scores between the two groups(P>0.05);at 6 h,24 h and 72 h after operation,the MMSE scores in group B were(25.7±2.8),(27.6±1.4)and(28.4±1.1),all significantly higher than[(22.2±3.6),(25.4±2.2)and(27.8±1.2),respectively,P<0.05]in group A;during operation,the HR in group B was(79.5±11.6)beats/min,faster than[(74.1±12.4)beats/min,P<0.05]in group A,while before induction of and 6 hr after anesthesia,there were no significant differences respect to the HR,MAP and SpO_(2) between the two groups(P>0.05);the total incidence of adverse reactions in group B was(23.2%),much higher than 7.4%(P<0.05)in group A.Conclusion The sevoflurane and propofol combination venous-inhalation anesthesia has a good anesthetic effect in the radical surgery of patients with PLC,and as compared with small dose,the administration of large dose of sevoflurane could obtain a better postoperative consciousness recovery,with a little more untoward reactions,which should be carefully evaluated before the operation.

关 键 词：原发性肝癌 肝叶切除术 七氟醚 丙泊酚 静-吸复合麻醉 

分 类 号：R614[医药卫生—麻醉学] R735.7[医药卫生—外科学]