摘要:
目的 探讨舒芬太尼复合丙泊酚静脉麻醉对高海拔地区食管癌根治术患者术中血流动力学及氧代谢的影响.方法 选取2015年3月至2017年3月在本院行食管癌根治术的患者60例,按照随机数字表法分为两组,每组30例,对照组患者给予芬太尼复合丙泊酚静脉麻醉,观察组患者给予舒芬太尼复合丙泊酚静脉麻醉.观察两组患者麻醉恢复期间躁动症状发生情况,记录患者停药后至自主呼吸恢复时间、拔管时间及手术前后简易智力状态检查量表(MMSE)评分情况,并对两组患者麻醉诱导前(T0)、气管插管时(T1)、切皮时(T2)、开胸时(T3)、游离食管时(T4)、拔除导管时(T5)的血流动力学指标及氧代谢指标进行分析.结果 观察组患者自主呼吸恢复时间及拔管时间均明显短于对照组(P<0.05),观察组患者麻醉恢复期间躁动程度弱于对照组,差异有统计学意义(P<0.05).对照组在T2~T14时间点MAP均明显高于T0(P <0.05),但观察组在T2~T4时间点MAP、HR明显低于T0(P<0.05);与T0时间点比较,两组T1~T5时间点SpO2、SvO2、DO2均明显降低(P<0.05),T2~T4时间点VO2明显升高(P<0.05),其中对照组变化尤为明显(P<0.05).两组术后1d时的MMSE评分均较术前明显下降(P<0.05),其中观察组明显低于对照组,差异有统计学意义(P<0.05).结论 舒芬太尼复合丙泊酚静脉麻醉较芬太尼复合丙泊酚静脉麻醉更有助于维持血流动力学稳定和氧代谢平衡,且对患者术后麻醉恢复和认知功能影响较小.%Objective To investigate the effect of intravenous anesthesia with sufentanil combined with propofol on hemodynamics and oxygen metabolism in patients with esophageal cancer under high altitude.Methods 60 patients with esophageal cancer radical surgery was selected from March 2015 to March 2017 in our hospital and were divided into two groups according to the random number table,30 patients in each group.Patients in the control group were given with fentanyl and propofol intravenous anesthesia,and patients in the observation group were given sufentanil combined with propofol anesthesia.The occurrence of restlessness during the recovery of anesthesia in the two groups were observed,the spontaneous breathing recovery time,extubation time and postoperative Mini-mental State Examination (MMSE) score were recorded,and the indexes of hemodynamics and oxygen metabolism were measured at the time of before induction of anesthesia (T0),tracheal intubation (T1),skin incision (T2),thoracotomy (T3),free esophagus (T4),esophageal catheter removal time (T5).Results The spontaneous respiration recovery time and extubation time of the observation group were significantly shorter than those of the control group (P < 0.05).The degree of restlessness in the observation group was weaker than that in the control group (P < 0.05).Mean arterial pressure (MAP) in the control group at T2-T4 were significantly higher than those in T0 (P < 0.05),but MAP and heart rate (HR) in the observation group at T1-T5 were significantly lower than those of T0 (P < 0.05).Compared with T0 group,oxygen saturation (SpO2),oxygen saturation of mixed venose blood (SvO2) and oxygen delivery (DO2) at T1-T5 were significantly decreased (P < 0.05),oxygen consumption (VO2) at T2-T4 was significantly increased (P < 0.05),especially in the control group (P < 0.05).The MMSE scores of the two groups were significantly lower than those before the operation (P < 0.05),and the scores in observation group was significantly higher than the control group (P < 0.05).Conclusions The intravenous anesthesia with sufentanil combined with propofol is more helpful in maintaining hemodynamic stability and oxygen metabolism balance than intravenous anesthesia with fentanyl combined with propofol and has little effect on postoperative anesthesia recovery and cognitive function.