七氟烷吸入联合硬膜外麻醉在老年消化道恶性肿瘤手术中的效果

发布时间：2018-05-06 05:10

本文选题：七氟烷 + 麻醉　；参考：《中国老年学杂志》2016年16期

【摘要】：目的探讨七氟烷吸入联合硬膜外麻醉在老年消化道恶性肿瘤切除术中的临床效果。方法 74例接受消化道恶性肿瘤切除术的老年患者,按麻醉方式不同分为单纯麻醉组35例和联合麻醉组39例,记录各手术时间点脑电双频指数(BIs)、吸入气浓度(Fi)和呼出气浓度(Et),气管插管后5 min(T0)、单肺通气开始时(T1)、单肺通气后30 min(T2)、60 min(T3)、90 min(T4)、恢复双肺通气时(T5)、恢复双肺通气后10 min(T6)及手术结束时(T7)分别监测患者心率(HR)、收缩压(SBP)和舒张压(DBP);麻醉前和麻醉后24 h测定白细胞PK与G6PD活性;手术前后采用简易精神状态评价量表(MMSE)对两组患者认知功能进行评分。结果联合麻醉组患者的HR、SBP和DBP波动显著小于单纯麻醉组,尤在T1和T5时,单纯麻醉组变化最明显(P0.05)。麻醉后24 h两组白细胞PK和G6PD活性较麻醉前明显升高,且联合麻醉组明显高于单纯麻醉组(P0.05);单纯麻醉组麻醉恢复时、术后1、3、7 d的MMSE评分均显著低于联合麻醉组(P0.05)。结论七氟烷吸入联合硬膜外麻醉能达到满意的临床麻醉深度和效果,且有利于保护患者的心肺功能、改善术后认知功能障碍。
[Abstract]:Objective to investigate the clinical effect of sevoflurane inhalation combined with epidural anesthesia in the resection of digestive tract malignant tumors in the elderly. Methods 74 elderly patients undergoing resection of malignant tumors of digestive tract were divided into simple anesthesia group (35 cases) and combined anesthesia group (39 cases) according to different anesthetic methods. EEG bispectral index (BIsa), inhaled gas concentration (Fig) and exhaled air concentration (Etl) were recorded at each operating time point, 5 min after endotracheal intubation, 5 min after endotracheal intubation, 30 min after single lung ventilation, 60 min T3 + 90 min T4, 10 min after restoration of bipulmonary ventilation, 10 min after T6) and 30 min after single lung ventilation. At the end of operation, T7) was used to monitor heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) respectively, and to detect leukocyte competition and G6PD activity before anesthesia and 24 hours after anesthesia. The cognitive function was evaluated by MMSE before and after operation. Results the fluctuation of HRP and DBP in the combined anesthesia group was significantly lower than that in the simple anesthesia group, especially at T1 and T5. WBC competition and G6PD activity in the two groups were significantly higher than those before anesthesia 24 h after anesthesia, and the MMSE scores of the combined anesthesia group were significantly lower than those of the combined anesthesia group on the 1st and 7th day after anesthesia recovery, and were significantly higher in the combined anesthesia group than in the simple anesthesia group. Conclusion sevoflurane inhalation combined with epidural anesthesia can achieve satisfactory clinical anesthetic depth and effect, and can protect patients' cardiopulmonary function and improve postoperative cognitive dysfunction.
【作者单位】：解放军117医院麻醉科;
【分类号】：R614;R735

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