丙泊酚靶控输注复合地氟烷吸入麻醉用于老年妇科腹腔镜手术的效果
发布时间：2018-12-16 12:27
【摘要】：目的:观察丙泊酚靶控输注(TCI)复合地氟烷吸入麻醉维持用于老年妇科腹腔镜手术患者的效果。方法:将90例择期行老年妇科腹腔镜手术的患者,采用随机数字表法随机分为P组:丙泊酚TCI,PD组:丙泊酚TCI复合地氟烷吸入和D组:地氟烷吸入,每组30例。麻醉诱导,可视喉镜下行气管插管,接呼吸机行机械通气。麻醉维持:P组丙泊酚血浆靶浓度3~4μg/ml,PD组在P组的基础上复合吸入地氟烷2%~3%,D组吸入地氟烷5%~8%。标记各组患者在入室时(T0)、气管插管即刻(T1)、气管插管后5min(T2)、二氧化碳气腹建立即刻(T3)、气腹建立后5min(T4)、气腹建立后15min(T5)、气腹建立后25min(T6)、气管拔管即刻(T7)、气管拔管后5min(T8)各时刻的血流动力学参数;采集T0和T8两个时间点的静脉血,测定血浆中T-AOC,SOD,GSH-Px,MDA和VE的值。记录自主呼吸恢复时间、听指令睁眼时间、拔管时间、苏醒室(PACU)停留时间、手术时间、术中出血量、术后恶心呕吐(PONV)例数和躁动例数。结果:1.一般资料及手术情况三组患者的平均年龄、平均体重、平均手术时间、术中出血量的中位数比较差异均无统计学意义(P0.05)。2.围术期血流动力学改变在气管插管即刻(T1)、气腹即刻(T3)以及拔管(T7)时,各组的MAP、HR与其相对应的基础值相比均有所增加,PD组在气腹即刻(T3)、气腹建立后5min(T4)、气腹建立后15min(T5)时的MAP和在T3时的HR比P组在该时刻对应值更低(P㩳0.05),与D组比较无差异(P0.05),但总体上三组均未发生严重血流动力学改变。3.氧化应激的结果P组在气管拔管后5min(T8)的T-AOC值高于入室时(T0),差异有统计学意义(P㩳0.05);D组在T8时的T-AOC和VE值低于T0,差异有统计学意义(P㩳0.05);余各值差异无统计意义。组间比较:在T8时,P组的T-AOC值分别高于D组和PD组(P㩳0.05);余各值差异无统计意义。4.三组患者的早期恢复情况P组在听指令睁眼时间和拔管时间上长于PD组和D组,差异有统计学意义(P㩳0.05)。5.术后恶心呕吐与躁动P组和PD组早期(PACU内)恶心呕吐发生率(3.33%)低于D组(26.67%)(P㩳0.05),而三组在病房的PONV和躁动发生率无明显差异(P0.05)。结论:三种麻醉均可安全用于老年妇科腹腔镜手术,丙泊酚TCI复合地氟烷吸入的麻醉维持方法,术中血流动力学更稳定,围术期氧化应激影响小,术后早期恢复更快且恶心呕吐发生率低。
[Abstract]:Objective: to observe the efficacy of target controlled infusion of propofol (TCI) combined with desflurane inhalation anesthesia in elderly patients undergoing gynecological laparoscopic surgery. Methods: ninety elderly patients undergoing laparoscopic gynecologic surgery were randomly divided into group P (n = 30): propofol TCI,PD group (n = 30), propofol TCI combined desflurane inhalation group (n = 30) and desflurane inhalation group (n = 30). Anesthesia induction, intubation under visual laryngoscope, mechanical ventilation by ventilator. Anesthesia maintenance: the plasma target concentration of propofol in group P was 3 ~ 4 渭 g 路ml ~ (-1) / d. On the basis of group P, desflurane _ 2 was inhaled and desflurane was inhaled in group D. At the time of entry (T 0), tracheal intubation (T 1), 5min (T 2) after tracheal intubation, carbon dioxide pneumoperitoneum (T 3), 5min (T 4) after pneumoperitoneum and 15min (T 5) after pneumoperitoneum were observed. The hemodynamic parameters of 25min (T6), immediate tracheal extubation (T7) and 5min (T8) after extubation of pneumoperitoneum were observed. The venous blood samples were collected at T0 and T8 time points to determine the levels of GSH-PxCX MDA and VE in plasma. The recovery time of spontaneous respiration, the time of opening eyes, the time of extubation, the staying time of (PACU) in the awake room, the time of operation, the amount of blood lost during operation, the (PONV) cases of nausea and vomiting after operation and the number of restlessness were recorded. Results: 1. There was no significant difference in average age, average body weight, mean operative time and median amount of intraoperative bleeding among the three groups (P0.05). The changes of hemodynamics in perioperative period were increased at the time of tracheal intubation (T1), pneumoperitoneum (T3) and extubation (T7). The MAP,HR of each group was increased compared with the corresponding basic values, and that of PD group was immediately after pneumoperitoneum (T3). The corresponding values of 5min (T4) after pneumoperitoneum, 15min (T5) after pneumoperitoneum and HR at T3 were lower than those in group P (P0. 05), but there was no difference between group D and group D (P0.05). But on the whole, no serious hemodynamic changes occurred in the three groups. The results of oxidative stress showed that the T-AOC value of 5min (T8) after extubation in group P was higher than that at the time of extubation (T0), and the difference was statistically significant (P0. 05). The values of T-AOC and VE in group D at T8 were lower than those in T0, the difference was statistically significant (P0. 05), but there was no statistical significance in other values. Comparison between groups: at T8, the T-AOC value of P group was higher than that of D group and PD group (P0. 05), and the other values had no statistical significance. 4. The early recovery in group P was longer than that in group PD and group D (P 0.05). The incidence of nausea and vomiting (3.33%) was lower than that in group D (26.67%) in group P and PD (P < 0.05), but there was no significant difference in PONV and restlessness among the three groups (P0.05). Conclusion: all three kinds of anesthesia can be safely used in laparoscopic surgery for elderly gynecological patients. Propofol TCI combined with desflurane inhalation can maintain anesthesia. The hemodynamics is more stable during operation, and the effect of oxidative stress on perioperative period is less than that of propofol TCI. Early postoperative recovery was faster and the incidence of nausea and vomiting was low.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
本文编号：2382341
[Abstract]:Objective: to observe the efficacy of target controlled infusion of propofol (TCI) combined with desflurane inhalation anesthesia in elderly patients undergoing gynecological laparoscopic surgery. Methods: ninety elderly patients undergoing laparoscopic gynecologic surgery were randomly divided into group P (n = 30): propofol TCI,PD group (n = 30), propofol TCI combined desflurane inhalation group (n = 30) and desflurane inhalation group (n = 30). Anesthesia induction, intubation under visual laryngoscope, mechanical ventilation by ventilator. Anesthesia maintenance: the plasma target concentration of propofol in group P was 3 ~ 4 渭 g 路ml ~ (-1) / d. On the basis of group P, desflurane _ 2 was inhaled and desflurane was inhaled in group D. At the time of entry (T 0), tracheal intubation (T 1), 5min (T 2) after tracheal intubation, carbon dioxide pneumoperitoneum (T 3), 5min (T 4) after pneumoperitoneum and 15min (T 5) after pneumoperitoneum were observed. The hemodynamic parameters of 25min (T6), immediate tracheal extubation (T7) and 5min (T8) after extubation of pneumoperitoneum were observed. The venous blood samples were collected at T0 and T8 time points to determine the levels of GSH-PxCX MDA and VE in plasma. The recovery time of spontaneous respiration, the time of opening eyes, the time of extubation, the staying time of (PACU) in the awake room, the time of operation, the amount of blood lost during operation, the (PONV) cases of nausea and vomiting after operation and the number of restlessness were recorded. Results: 1. There was no significant difference in average age, average body weight, mean operative time and median amount of intraoperative bleeding among the three groups (P0.05). The changes of hemodynamics in perioperative period were increased at the time of tracheal intubation (T1), pneumoperitoneum (T3) and extubation (T7). The MAP,HR of each group was increased compared with the corresponding basic values, and that of PD group was immediately after pneumoperitoneum (T3). The corresponding values of 5min (T4) after pneumoperitoneum, 15min (T5) after pneumoperitoneum and HR at T3 were lower than those in group P (P0. 05), but there was no difference between group D and group D (P0.05). But on the whole, no serious hemodynamic changes occurred in the three groups. The results of oxidative stress showed that the T-AOC value of 5min (T8) after extubation in group P was higher than that at the time of extubation (T0), and the difference was statistically significant (P0. 05). The values of T-AOC and VE in group D at T8 were lower than those in T0, the difference was statistically significant (P0. 05), but there was no statistical significance in other values. Comparison between groups: at T8, the T-AOC value of P group was higher than that of D group and PD group (P0. 05), and the other values had no statistical significance. 4. The early recovery in group P was longer than that in group PD and group D (P 0.05). The incidence of nausea and vomiting (3.33%) was lower than that in group D (26.67%) in group P and PD (P < 0.05), but there was no significant difference in PONV and restlessness among the three groups (P0.05). Conclusion: all three kinds of anesthesia can be safely used in laparoscopic surgery for elderly gynecological patients. Propofol TCI combined with desflurane inhalation can maintain anesthesia. The hemodynamics is more stable during operation, and the effect of oxidative stress on perioperative period is less than that of propofol TCI. Early postoperative recovery was faster and the incidence of nausea and vomiting was low.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
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