七氟烷联合靶控输注瑞芬太尼对老年胃癌患者围麻醉期的影响
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摘要
目的对比七氟烷和丙泊酚结合靶控输入瑞芬太尼对老年胃癌患者围麻醉期的影响。方法选取全身麻醉胃癌根治手术的老年患者158例,依据随机数字表法将其分成2组,观察组(79例)吸入七氟烷结合靶控输入瑞芬太尼麻醉,对照组(79例)靶控输入丙泊酚结合瑞芬太尼麻醉。观察麻醉诱导之前(T0)、患者切皮时(T1)、手术结束(T2)和拔管(T3)时HR、DP、SP、MAP和血压心率积(RPP),患者拔管时间、睁眼时间、使用血管活性药物和不良反应状况,采用视觉模拟评分(VAS)及Ramsay镇静评分检测患者术后6、12、24 h疼痛及镇静状况。结果观察组和对照组患者在T0、T1、T2、T3时间点内SP、DP、RPP、HR及MAP对比,差异均无统计学意义(P> 0. 05)。观察组患者睁眼、拔管时间低于对照组,差异有统计学意义(P <0. 05)。观察组血管活性药物使用率为21. 52%,对照组为25. 32%,差异无统计学意义(P>0. 05)。观察组患者术后6、12、24 h VAS评分及12、24 h镇静评分均低于对照组,差异有统计学意义(P <0. 05)。观察组不良反应发生率为21. 52%,对照组为18. 99%,差异无统计学意义(P> 0. 05)。结论丙泊酚或七氟烷联合靶控输注瑞芬太尼对老年胃癌患者麻醉效果与安全性均比较理想,但七氟烷联合瑞芬太尼麻醉患者术后清醒更快,术后疼痛改善更明显,临床应用价值更高。
Objective To compare the effects of seven halothane and propofol combined with target controlled infusion of remifentanil on elderly patients with gastric cancer during the perianesthesia. Methods A total of 158 elderly patients undergoing radical gastrectomy under general anesthesia were selected,then They were divided into two groups according to the random number table. Observation group( 79 cases) was anesthetized with seven halothane combined with target controlled infusion,control group( 79 cases) was anesthetized with propofol combined with target controlled infusion. HR,DP,SP,MAP and rate-pressure product( RPP) were observed before anesthesia induction( T0),at the time of patient curettage( T1),the end of surgery( T2)and extubation( T3),and the extubation time,eye opening time,use of vasoactive drugs and adverse reactions were observed. Visual analogue scale( VAS) and Ramsay sedation scale were used to detect postoperative pain and sedation of patients at 6,12 and24 h. Results There were no significant differences in SP,DP,RPP,HR and MAP between the observation group and the control group at T0,T1,T2 and T3( P > 0. 05); The eye opening time and extubation time of the observation group were lower than those of the control group( P < 0. 05); The usage rate vasoactive drugs of the observation group was 21. 52%,and that of the control group was 25. 32%( P > 0. 05). VAS scores at 6,12 and 24 h after surgery and sedation scores at 12 and 24 h after surgery of the observation group were lower than those of the control group( P < 0. 05). The incidence of adverse reactions of the observation group was 21. 52%,and that of the control group was 18. 99%( P > 0. 05). Conclusion Propofol and seven halothane combined with target controlled infusion of remifentanil has ideal effects on elderly patients with gastric cancer during the effect and Safety of anesthesia,but the patients during anesthesia with seven halothane combined with target controlled infusion is wake up faster after surgery,postoperative pain improve more significantly,and has higher clinical value.
Objective To compare the effects of seven halothane and propofol combined with target controlled infusion of remifentanil on elderly patients with gastric cancer during the perianesthesia. Methods A total of 158 elderly patients undergoing radical gastrectomy under general anesthesia were selected,then They were divided into two groups according to the random number table. Observation group( 79 cases) was anesthetized with seven halothane combined with target controlled infusion,control group( 79 cases) was anesthetized with propofol combined with target controlled infusion. HR,DP,SP,MAP and rate-pressure product( RPP) were observed before anesthesia induction( T0),at the time of patient curettage( T1),the end of surgery( T2)and extubation( T3),and the extubation time,eye opening time,use of vasoactive drugs and adverse reactions were observed. Visual analogue scale( VAS) and Ramsay sedation scale were used to detect postoperative pain and sedation of patients at 6,12 and24 h. Results There were no significant differences in SP,DP,RPP,HR and MAP between the observation group and the control group at T0,T1,T2 and T3( P > 0. 05); The eye opening time and extubation time of the observation group were lower than those of the control group( P < 0. 05); The usage rate vasoactive drugs of the observation group was 21. 52%,and that of the control group was 25. 32%( P > 0. 05). VAS scores at 6,12 and 24 h after surgery and sedation scores at 12 and 24 h after surgery of the observation group were lower than those of the control group( P < 0. 05). The incidence of adverse reactions of the observation group was 21. 52%,and that of the control group was 18. 99%( P > 0. 05). Conclusion Propofol and seven halothane combined with target controlled infusion of remifentanil has ideal effects on elderly patients with gastric cancer during the effect and Safety of anesthesia,but the patients during anesthesia with seven halothane combined with target controlled infusion is wake up faster after surgery,postoperative pain improve more significantly,and has higher clinical value.
引文
[1]吕宝胜,王卓强,王卫,等.七氟烷或丙泊酚复合瑞芬太尼麻醉在重症肌无力患者胸腺切除术中的应用[J].解放军医学杂志,2013,38(7):586-590.
[2]陈元良,徐丽丽,蓝志坚,等.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[J].中华全科医学,2017,15(2):198-201.
[3]聂颖,李韧韧,冯毅刚,等.不同麻醉方法在听神经瘤切除术时面神经监测中的应用比较[J].中华神经医学杂志,2013,12(7):680-684.
[4]Zhang L,Chen C,Wang L,et al.Awakening from anesthesia using propofol or sevoflurane with epidural block in radical surgery for senile gastric cancer[J].International Journal of Clinical Experimental Medicine,2015,8(10):19412-19420.
[5]吴迪.采用七氟烷或丙泊酚/瑞芬太尼全身麻醉行妇科手术临床研究[J].中国医师进修杂志,2014,37(18):9-11.
[6]盖春安,朱智瑞,胡智勇,等.七氟烷与瑞芬太尼复合丙泊酚在小儿唇腭裂修补术中的麻醉效果[J].中华医学杂志,2013,93(23):1819-1821.
[7]Hernández-Palazón J,Izura V,Fuentes-García D,et al.Comparison of the effects of propofol and sevoflurane combined with remifentanil on transcranial electric motor-evoked and somatosensory-evoked potential monitoring during brainstem surgery[J].Journal of Neurosurgical Anesthesiology,2015,27(4):282-288.
[8]徐浩苗.七氟烷、丙泊酚联合瑞芬太尼对重度子痫前期孕妇行剖宫产术中对血流动力学的影响[J].北京医学,2017,9(4):375-378.
[9]陈受琳,胡衍辉,卢俊,等.七氟烷或丙泊酚复合瑞芬太尼的麻醉苏醒质量比较[J].中国新药与临床杂志,2014,21(6):432-435.
[10]韩静,牛悦峰,刘毅,等.不同靶浓度丙泊酚与七氟烷复合麻醉用于老年胃癌患者手术的比较[J].中国药物与临床,2013,13(1):72-74.
[11]Hsiao HT,Wu H,Huang PC,et al.The effect of propofol and sevoflurane on antioxidants and proinflammatory cytokines in a porcine ischemia-reperfusion model[J].Acta Anaesthesiologica Taiwanica Official Journal of the Taiwan Society of Anesthesiologists,2015,54(1):6-10.
[12]何永传,苏健玲.七氟烷麻醉联合瑞芬太尼对老年冠状动脉粥样硬化性心脏病患者胃癌根治术中心肌功能及应激反应的影响[J].河北医学,2017,23(6):978-981.
[13]T.Gürsoy,K.T.Sarao?lu,P.C.Din9er,et al.The assessment of early postoperative neurocognitive functions in geriatric patients following sevoflurane-nitrous oxide inhalation anesthesia and intravenous propofol-remifentanil[J].Anestezi Dergisi,2015,22(4):202-206.
[14]申林.七氟烷联合靶控输注瑞芬太尼在全身麻醉的效果分析[J].上海医学,2017,40(3):179-180.
[15]高艳,刘波,刘辉,等.七氟烷与丙泊酚麻醉对甲状腺术后头痛、头晕及恶心、呕吐的影响[J].中国临床医生杂志,2016,44(6):69-71.
[16]倪红伟,贺广宝,张瑛,等.经喉罩七氟烷联合瑞芬太尼在日间手术中的应用[J].上海医学,2013,36(10):887-889.
[17]范玲玲,丁翠霞,陈冬梅.不同麻醉方法对老年颅内胃癌患者术后不同时段认知功能的影响研究[J].实用胃癌学杂志,2017,31(3):238-241.
[18]戚宝和,侍羽,包全堂,等.七氟烷联合瑞芬太尼对全身麻醉患者术中相关指标和术后苏醒质量的影响[J].中国药房,2015,26(33):4649-4651.
[2]陈元良,徐丽丽,蓝志坚,等.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[J].中华全科医学,2017,15(2):198-201.
[3]聂颖,李韧韧,冯毅刚,等.不同麻醉方法在听神经瘤切除术时面神经监测中的应用比较[J].中华神经医学杂志,2013,12(7):680-684.
[4]Zhang L,Chen C,Wang L,et al.Awakening from anesthesia using propofol or sevoflurane with epidural block in radical surgery for senile gastric cancer[J].International Journal of Clinical Experimental Medicine,2015,8(10):19412-19420.
[5]吴迪.采用七氟烷或丙泊酚/瑞芬太尼全身麻醉行妇科手术临床研究[J].中国医师进修杂志,2014,37(18):9-11.
[6]盖春安,朱智瑞,胡智勇,等.七氟烷与瑞芬太尼复合丙泊酚在小儿唇腭裂修补术中的麻醉效果[J].中华医学杂志,2013,93(23):1819-1821.
[7]Hernández-Palazón J,Izura V,Fuentes-García D,et al.Comparison of the effects of propofol and sevoflurane combined with remifentanil on transcranial electric motor-evoked and somatosensory-evoked potential monitoring during brainstem surgery[J].Journal of Neurosurgical Anesthesiology,2015,27(4):282-288.
[8]徐浩苗.七氟烷、丙泊酚联合瑞芬太尼对重度子痫前期孕妇行剖宫产术中对血流动力学的影响[J].北京医学,2017,9(4):375-378.
[9]陈受琳,胡衍辉,卢俊,等.七氟烷或丙泊酚复合瑞芬太尼的麻醉苏醒质量比较[J].中国新药与临床杂志,2014,21(6):432-435.
[10]韩静,牛悦峰,刘毅,等.不同靶浓度丙泊酚与七氟烷复合麻醉用于老年胃癌患者手术的比较[J].中国药物与临床,2013,13(1):72-74.
[11]Hsiao HT,Wu H,Huang PC,et al.The effect of propofol and sevoflurane on antioxidants and proinflammatory cytokines in a porcine ischemia-reperfusion model[J].Acta Anaesthesiologica Taiwanica Official Journal of the Taiwan Society of Anesthesiologists,2015,54(1):6-10.
[12]何永传,苏健玲.七氟烷麻醉联合瑞芬太尼对老年冠状动脉粥样硬化性心脏病患者胃癌根治术中心肌功能及应激反应的影响[J].河北医学,2017,23(6):978-981.
[13]T.Gürsoy,K.T.Sarao?lu,P.C.Din9er,et al.The assessment of early postoperative neurocognitive functions in geriatric patients following sevoflurane-nitrous oxide inhalation anesthesia and intravenous propofol-remifentanil[J].Anestezi Dergisi,2015,22(4):202-206.
[14]申林.七氟烷联合靶控输注瑞芬太尼在全身麻醉的效果分析[J].上海医学,2017,40(3):179-180.
[15]高艳,刘波,刘辉,等.七氟烷与丙泊酚麻醉对甲状腺术后头痛、头晕及恶心、呕吐的影响[J].中国临床医生杂志,2016,44(6):69-71.
[16]倪红伟,贺广宝,张瑛,等.经喉罩七氟烷联合瑞芬太尼在日间手术中的应用[J].上海医学,2013,36(10):887-889.
[17]范玲玲,丁翠霞,陈冬梅.不同麻醉方法对老年颅内胃癌患者术后不同时段认知功能的影响研究[J].实用胃癌学杂志,2017,31(3):238-241.
[18]戚宝和,侍羽,包全堂,等.七氟烷联合瑞芬太尼对全身麻醉患者术中相关指标和术后苏醒质量的影响[J].中国药房,2015,26(33):4649-4651.