地氟醚对老年腹腔镜结直肠癌手术病人麻醉恢复的影响

发布时间：2018-03-24 00:34

  本文选题：地氟醚　切入点：七氟醚　出处：《吉林大学》2017年硕士论文

【摘要】：目的:观察行腹腔镜结直肠癌根治术的老年患者,应用地氟醚或七氟醚进行麻醉维持,比较两者对老年患者行腹腔镜结直肠癌根治术麻醉恢复期的影响。方法:选择吉林大学第二医院2016年8月至2017年2月,择期行腹腔镜结直肠癌根治术65-80周岁的老年患者。ASA分级Ⅱ至Ⅲ级,手术时间大约3小时。符合纳入标准一共74例,随机分为两组:实验组地氟醚组(D组,38例)和对照组七氟醚组(S组,36例)。两组均采用相同的静脉诱导方法,缓慢注射:0.05mg/kg咪达唑仑、4μg/kg枸橼酸芬太尼、0.15mg/kg顺式阿曲库胺、0.03mg/kg依托咪酯进行麻醉诱导。地氟醚组从诱导结束成功插管后,开始吸入麻醉药进行麻醉维持,并且缓慢的增加地氟醚的体积分数,术中保持在6-8%的吸入,七氟醚组在手术中则持续吸入1.5-3%的七氟醚。两组患者保持吸入麻醉剂始终在1.3MAC左右。根据手术刺激和BIS值来调整吸入麻醉剂的体积分数,使术中BIS数值在45-60范围之间波动。吸入麻醉剂的同时,持续微量泵注盐酸瑞芬太尼5ug/(kg·h),术中间断(间隔30分钟)追加顺式阿曲库铵5mg,手术结束前半小时停止追加。分别在手术开皮时和手术结束前5分钟给予枸橼酸芬太尼0.1mg。分别记录两组患者进入手术室以后各时间点(入手术室T_0、插管即刻T_1、插管后10分钟T_2、手术开始30分钟T_3、手术结束T_4、拔管即刻T_5、拔管后10分钟T_6、拔管后20分钟T_7)的平均动脉压MAP(mm Hg)、心率HR(次/min);记录两组患者的手术时间、苏醒时间(手术结束后到可以听从命令进行睁眼、握手等动作的时间)、拔管时间(手术结束后至拔除口腔内气管导管的时间)、麻醉恢复室(PACU)停留时间,从病房监护室转到普通病房的时间(监护病房停留时间);记录在麻醉恢复室发生的不良事件,躁动、嗜睡(困倦、应对指令反应缓慢迟钝)、恶心呕吐、皮肤瘙痒、呼吸抑制(Sp O2≤90%)等。结果:1、两组患者的一般资料(年龄、ASA分级)比较,无统计学意义。2、在术中及苏醒期各时间点T_0、T_1、T_2、T_3、T_4、T_5、T_6、T_7的平均动脉压、心率无明显差异。3、地氟醚组患者在苏醒时间、拔管时间、苏醒室停留时间、从病房监护室转到普通病房的时间均短于七氟醚组(p0.05)。4、地氟醚组术后躁动评分低于七氟醚组(p0.05)。5、术后在PACU发生嗜睡、呼吸抑制的例数地氟醚组低于七氟醚组(p0.05),恶心呕吐和皮肤瘙痒的发生例数两者无明显差异。结论:在老年腹腔镜结直肠癌根治术中,应用地氟醚进行术中麻醉维持,拔管时间和苏醒时间缩短,可以提高苏醒期的质量和安全性、对麻醉恢复期的影响较小,同时也能够有效地加快麻醉恢复室(PACU)和手术室的周转,提高工作效率,减少资源浪费。在PACU患者的躁动评分和不良事件发生例数,地氟醚组均略低于七氟醚组。有利于老年患者术后恢复。由此可见,地氟醚可作为老年患者行腹腔镜结直肠癌手术的麻醉方案,有利于老年患者苏醒期的快速恢复。使ERAS这一理念在结直肠外科得以体现。
[Abstract]:Objective: To observe the effect of elderly patients underwent laparoscopic radical resection of colorectal cancer, application of desflurane or sevoflurane anesthesia wasmaintained, compare in aged patients undergoing laparoscopic radical resection of colorectal cancer on anesthesia recovery period. Methods: the second hospital of Jilin University from August 2016 to February 2017,.ASA grade II to III elderly patients undergoing laparoscopic radical resection of colorectal cancer 65-80 the age, operation time is about 3 hours. A total of 74 patients met the inclusion criteria, were randomly divided into two groups: experimental group desflurane group (group D, 38 cases) and control group (sevoflurane group S group, 36 cases). Induction method, two groups were treated with the same intravenous injection of midazolam: 0.05mg/kg 4 g/kg, fentanyl citrate, 0.15mg/kg cisatracurium, 0.03mg/kg etomidate anesthesia induced by desflurane group induced from the end. Successful intubation, inhalation anesthesia medicine began to maintain anesthesia, and And the slow increase of the volume fraction of desflurane, were maintained at 6-8% sevoflurane inhalation, sevoflurane group in the operation of continuous inhalation of 1.5-3%. Two groups of patients remain always inhalation anesthetic at about 1.3MAC. To adjust the volume fraction of inhaled anesthetics according to surgical stimulation and BIS value, so that the value of intraoperative BIS fluctuations in the range between 45-60 at the same time. Inhalation anesthetic, continuous micro pump injection of remifentanil hydrochloride 5ug/ (kg - H), intraoperative intermittent (30 minute intervals) additional 5mg of cisatracurium, half an hour before the end of operation. At the end of surgery were added to stop open skin and 5 minutes before surgery given fentanyl citrate 0.1mg. were recorded after two groups patients entered the operation room at each time point (T_0 T_1 into the operation room, intubation, intubation after 10 minutes of operation T_2, 30 minutes to start the T_3 T_4, the end of surgery, extubation T_5, 10 min after extubation T_6, 20 min after extubation T_ 7)鐨勫钩鍧囧姩鑴夊帇MAP(mm Hg),蹇冪巼HR(娆，

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