不同浓度七氟烷瑞芬太尼静吸复合麻醉在消化道肿瘤根治术中应用及对术中血流动力学、术后麻醉恢复的影响  

Application of different concentrations of sevoflurane with remifentanil in radical surgery for gastrointestinal tumors:Effects on intraoperative hemodynamics and postoperative anesthetic recovery

作　　者：王莹[1] 周蔚蓝 冯定祥[1] Ying Wang;Wei-Lan Zhou;Ding-Xiang Feng(Panan County People’s Hospital of Jinhua City,Jinhua 322300,Zhejiang Province,China)

机构地区：[1]金华市磐安县人民医院麻醉科,浙江省金华市322300

出　　处：《世界华人消化杂志》2022年第23期1039-1045,共7页World Chinese Journal of Digestology

摘　　要：背景瑞芬太尼、七氟烷复合能为患者提供充分的镇痛、镇静效果,消化道肿瘤手术麻醉不仅需达到手术所需麻醉深度,还需减轻手术应激,保证术后快速苏醒,本研究从不同角度对比不同浓度的七氟烷瑞芬太尼静吸复合麻醉的应用效果.目的探讨不同浓度七氟烷瑞芬太尼静吸复合麻醉在消化道肿瘤根治术中的应用及对术中血流动力学、术后麻醉恢复的影响.方法选取2020-01/2021-12我院行消化道肿瘤根治术患者86例,随机数字表法分为两组,每组43例.A组采取1.0最低肺泡有效浓度(minimum alveolar concentration,MAC)七氟烷瑞芬太尼静吸复合麻醉,B组采取1.5MAC七氟烷瑞芬太尼静吸复合麻醉.观察两组麻醉质量、术中血流动力学[平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)]、不同时间点脑氧代谢[脑氧摄取率(CERO_(2))、颈静脉血氧含量(SjvO_(2))],统计麻醉维持期间不良事件及术后麻醉恢复情况.结果麻醉维持期间,A组瑞芬太尼泵注速度调整率32.56%低于B组调整率67.44%(P<0.05);A组、B组各时间点HR、MAP平均值相比,无显著差异,且HR、MAP均在正常范围内;两组各时间点CERO_(2)、SjvO_(2)相比,无显著差异,两组T2、T3、T4、T5、T6时CERO_(2)均低于T1时,SjvO_(2)高于T1(P<0.05);麻醉维持期间A组低血压发生率低于B组(P<0.05);麻醉苏醒期A组听从指令睁眼、自主呼吸恢复、拔管及出室时间均短于B组(P<0.05).结论1.0 MAC、1.5 MAC七氟烷均能满足消化道肿瘤根治术的麻醉维持需求;但1.0 MAC七氟烷能提供更好的麻醉维持质量,以减少麻醉维持期间瑞芬太尼速度调整次数,且脑氧代谢影响小,可明显提高苏醒质量,缩短麻醉苏醒时间,有利于加快临床周转.BACKGROUND The combination of remifentanil and sevoflurane can provide patients with sufficient analgesic and sedative effects.Anesthesia for gastrointestinal tumor surgery not only needs to reach the required depth of anesthesia for surgery,but also needs to reduce the surgical stress to ensure rapid recovery after surgery.AIM To explore the application of different concentrations of sevoflurane with remifentanil in radical surgery for gastrointestinal tumors and the effects on intraoperative hemodynamics and postoperative anesthesia recovery.METHODS Eighty-six patients undergoing radical surgery for gastrointestinal tumors at our hospital from January 2020 to December 2021 were selected and divided into two groups by random number table method,with 43 cases in each group.Sevoflurane at a 1.0 minimum alveolar effective concentration(MAC)with remifentanil was adopted in group A,and 1.5 MAC sevoflurane with remifentanil was adopted in group B.The quality of anesthesia,intraoperative hemodynamics[mean arterial pressure(MAP)and heart rate(HR)],cerebral oxygen metabolism[cerebral oxygen uptake rate(CERO_(2))and jugular venous oxygen content(SjvO_(2))]at different time points,adverse events during anesthesia maintenance,and postoperative anesthesia recovery were recorded in the two groups.RESULTS During maintenance of anesthesia,the rate of adjustment of remifentanil pumping rate was lower in group A than in group B(32.56%vs 67.44%,P<0.05).There was no significant difference in HR or MAP at each time point between the two groups(P>0.05),and both HR and MAP were within the normal range.There was no significant difference in CERO_(2)or SjvO_(2)at each time point between the two groups(P>0.05);CERO_(2)at T2,T3,T4,T5,and T6 in both groups was lower than that at T1,and SjvO_(2)was higher than that at T1(P<0.05).The incidence of hypotension during anesthesia maintenance in group A was lower than that in group B(P<0.05).The times to open eyes on command,recovery of spontaneous breathing,extubation,and exit from the room duri

关 键 词：七氟烷 复合麻醉 瑞芬太尼 消化道肿瘤 

分 类 号：R614[医药卫生—麻醉学] R735[医药卫生—外科学]