不同浓度七氟醚联合丙泊酚麻醉对腹腔镜肝癌切除术患者术后苏醒及安全性的影响

摘要

Objective To investigate the effects of different concentrations of sevoflurane combined with propofol anes-thesia on recovery and safety of liver cancer patients after laparoscopic hepatectomy. Methods 60 cases of liver cancer treated by laparoscopic hepatectomy were selected and divided into the experimental group A, the experimental group B and the control group,20 cases in each group. All patients were treated with PMOD,the experimental group A was given 0. 5 MAC sevoflurane combined with propofol anesthesia,the experimental group B was given 1 MAC sevoflurane combined with propofol anesthesia,the control group were given intravenous anesthesia with propofol. Extubation immediately (T0),extubation after 5min (T1) and ex-tubation 15 T2 ( min) SPO2 ,HR,MAP and OAA/S score,modified Aldrete score of the 3 groups were observed and compared. The dosage of propofol,anesthesia time,recovery time,recovery time and extubation time were recorded and compared among the 3 groups. The 3 groups after anesthesia agitation situation were recorded and compared. Results T0 and T1,HR values of the ex-perimental group A and the experimental group B were significantly lower than that of the control group (P<0. 05),the HR val-ues of the experimental group B was significantly lower than that of the experimental group A (P<0. 05);T0,MAP values of the experimental group A and the experimental group B were significantly higher than that of the control group (P <0. 05). The propofol,recovery time and extubation time of the experimental group A and the experimental group B were significantly lower than those of the control group (P<0. 05);spontaneous breathing recovery time (22. 6 ± 12. 5)of the experimental group B was lower than that of the control group (22. 6 ± 12. 5) min (P<0. 05). The OAA/S score and modified Aldrete score of the experimental group B and the experimental group were significantly higher than those of the control group A (P<0. 05). There was no signifi cant difference between the experimental group and the control group ( P > 0 . 05 ) . Indicators to improve the situation was to strengthen the dependence of sevoflurane. Conclusion Sevoflurane combined with propofol anesthesia can improve the recovery quality and safety of hepatocellular carcinoma patients after PMOD hepatectomy,and sevoflurane at dose of 1. 0 MAC are the most effective.%目的 探讨不同浓度七氟醚联合丙泊酚麻醉对腹腔镜肝癌切除术患者术后苏醒及安全性的影响.方法选取腹腔镜下多功能手术解剖器(peng's multi-functional operative dissector,PMOD)刮吸法断肝技术行腹腔镜肝癌切除术患者60例,分为实验组A、实验组B和对照组,每组各20例.全部患者均行PMOD术,实验组A选择0.5 MAC七氟醚联合静脉注射丙泊酚麻醉,实验组B选择1.0 MAC七氟醚联合静脉注射丙泊酚麻醉,对照组选择单纯静脉注射丙泊酚麻醉.观察和比较3组患者拔管即刻(T0)、拔管5 min后(T1)和拔管15 min后(T2)的SPO2、HR、MAP和OAA/S评分、改良Aldrete评分.记录和比较3组患者丙泊酚用量、麻醉时间、自主呼吸恢复时间、苏醒时间和拔管时间.记录和对比2组患者麻醉苏醒后躁动情况.结果T0和T1时,实验组A和实验组B患者HR值显著低于对照组患者(P<0.05),实验组B患者HR值显著低于实验组A患者(P<0.05);T0时,实验组A和实验组B患者MAP值显著高于对照组患者(P<0.05).实验组A和实验组B患者丙泊酚量、苏醒时间和拔管时间均显著低于对照组(P均<0.05);实验组B患者自主呼吸恢复时间为(22.6±12.5)min,显著低于对照组患者(22.6±12.5)min(P<0.05).实验组A和实验组B患者OAA/S评分和改良Aldrete评分显著高于对照组患者(P<0.05).实验组患者躁动情况和对照组患者比较,差异无统计学意义(P>0.05).各项指标改善情况均呈七氟醚依赖性加强.结论七氟醚复合丙泊酚麻醉有助于提高PMOD肝癌切除术患者术后的苏醒质量及安全性,且1.0 MAC七氟醚效果更佳.