异丙酚复合瑞芬太尼单肺通气麻醉对患者影响.docVIP

异丙酚复合瑞芬太尼单肺通气麻醉对患者影响[摘要] 目的：探讨异丙酚复合瑞芬太尼单肺通气麻醉对开胸手术患者呼吸、循环系统和应激反应的影响。方法：将择期行开胸手术患者60例，ASAⅠ~Ⅱ级，随机分为观察组和对照组，每组各30例。观察组（Ⅰ组）给予异丙酚复合瑞芬太尼麻醉，麻醉维持给予持续输注瑞芬太尼0.10~0.25 μg/（kgmin）和血浆靶控异丙酚1~3 μg/ml，间断静脉注射维库溴胺0.02 mg/kg；对照组（Ⅱ组）给予静吸复合麻醉，麻醉维持给予持续静脉输注瑞芬太尼0.10~0.25 μg/（kgmin） 和吸入1％~3％异氟烷，间断静脉注射维库溴胺0.02 mg/kg。连续监测患者血压（SBP）、心率（HR）、血氧饱和度（PaO2）、心电图、平均动脉压（MAP）、呼气末二氧化碳分压（PetCO2）和麻醉深度指数。分别在麻醉前基础值（T0）、手术切皮前5 min（T1）、切皮后5 min（T2）、切皮后（OLV期间）30 min（T3）和术毕前10 min（T4）采桡动脉血3 ml，评价两组患者的血气指标和应激反应程度。结果：T3时，Ⅰ组SpO2显著高于Ⅱ组，差异有统计学意义（P＜0.05）；T1、T2、T4时，Ⅰ组PaO2显著高于Ⅱ组，差异有统计学意义（P＜0.01）；T1时，Ⅰ组SBP显著低于Ⅱ组，差异有高度统计学意义（P＜0.01）；T1、T4时，Ⅰ组HR显著低于Ⅱ组，差异有统计学意义（P＜0.05）；T1时，Ⅰ组DBP显著高于Ⅱ组，T4时，Ⅰ组DBP显著低于Ⅱ组，差异有统计学意义（P＜0.05）；T3、T4时，Ⅰ组皮质醇（Cor）显著低于Ⅱ组，差异有统计学意义（P＜0.01，P＜0.05）；T4时，Ⅰ组血管紧张素Ⅱ显著高于Ⅱ组（P＜0.05）；T1、T2、T3、T4时，Ⅰ组IL-6显著低于Ⅱ组（P＜0.01）；各个时刻两组INS比较，差异无统计学意义（P0.05）。结论：异丙酚复合瑞芬太尼相对于异氟醚复合瑞芬太尼行单肺通气麻醉，对呼吸系统、循环系统的影响较小，应激反应较少，术中、术后并发症少。 [关键词] 异丙酚；瑞芬太尼；全凭静脉麻醉；单肺通气 [中图分类号] R971+.2 [文献标识码] A [文章编号] 1673-7210（2011）11（b）-079-03 Effect of Propofol combined with Remifentanil in one-lung ventilation anesthesia on patients TIAN Hua, XIANG Dengguo, WU Shuxuan Department of Anesthesiology, the Center Hospital of Enshi Autonomous Prefecture, Hubei Province, Enshi 445000, China [Abstract] Objective: To observe the effects of Propofol combined with Remifentanil anesthesia on the respiration, circulation system and stress reaction of patients during one-lung ventilation (OLV). Methods: 60 cases of ASAⅠ-Ⅱ patients for elective thoracic surgery were randomly divided into observation group and control group, each of 30 cases. Total intravenous anesthesia was given to the observation group (group Ⅰ), which was maintained with Propofol 1-3 μg/ml and continuous Remifentanil 0.10-0.25 μg/(kg?min), intermittent intravenous injection Vecuronium 0.02 mg/kg. Intravenous-inhalation anesthesia was given to the control group (groupⅡ), which was maintained with 1％-3％ Isoflurane inhalation and continuously intravenous Remifentanil 0.10-0.25 μg/(kgmin), interm