本文選題：地氟醚　切入點(diǎn)：七氟醚　出處：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:觀察行腹腔鏡結(jié)直腸癌根治術(shù)的老年患者,應(yīng)用地氟醚或七氟醚進(jìn)行麻醉維持,比較兩者對老年患者行腹腔鏡結(jié)直腸癌根治術(shù)麻醉恢復(fù)期的影響。方法:選擇吉林大學(xué)第二醫(yī)院2016年8月至2017年2月,擇期行腹腔鏡結(jié)直腸癌根治術(shù)65-80周歲的老年患者。ASA分級Ⅱ至Ⅲ級,手術(shù)時(shí)間大約3小時(shí)。符合納入標(biāo)準(zhǔn)一共74例,隨機(jī)分為兩組:實(shí)驗(yàn)組地氟醚組(D組,38例)和對照組七氟醚組(S組,36例)。兩組均采用相同的靜脈誘導(dǎo)方法,緩慢注射:0.05mg/kg咪達(dá)唑侖、4μg/kg枸櫞酸芬太尼、0.15mg/kg順式阿曲庫胺、0.03mg/kg依托咪酯進(jìn)行麻醉誘導(dǎo)。地氟醚組從誘導(dǎo)結(jié)束成功插管后,開始吸入麻醉藥進(jìn)行麻醉維持,并且緩慢的增加地氟醚的體積分?jǐn)?shù),術(shù)中保持在6-8%的吸入,七氟醚組在手術(shù)中則持續(xù)吸入1.5-3%的七氟醚。兩組患者保持吸入麻醉劑始終在1.3MAC左右。根據(jù)手術(shù)刺激和BIS值來調(diào)整吸入麻醉劑的體積分?jǐn)?shù),使術(shù)中BIS數(shù)值在45-60范圍之間波動(dòng)。吸入麻醉劑的同時(shí),持續(xù)微量泵注鹽酸瑞芬太尼5ug/(kg·h),術(shù)中間斷(間隔30分鐘)追加順式阿曲庫銨5mg,手術(shù)結(jié)束前半小時(shí)停止追加。分別在手術(shù)開皮時(shí)和手術(shù)結(jié)束前5分鐘給予枸櫞酸芬太尼0.1mg。分別記錄兩組患者進(jìn)入手術(shù)室以后各時(shí)間點(diǎn)(入手術(shù)室T_0、插管即刻T_1、插管后10分鐘T_2、手術(shù)開始30分鐘T_3、手術(shù)結(jié)束T_4、拔管即刻T_5、拔管后10分鐘T_6、拔管后20分鐘T_7)的平均動(dòng)脈壓MAP(mm Hg)、心率HR(次/min);記錄兩組患者的手術(shù)時(shí)間、蘇醒時(shí)間(手術(shù)結(jié)束后到可以聽從命令進(jìn)行睜眼、握手等動(dòng)作的時(shí)間)、拔管時(shí)間(手術(shù)結(jié)束后至拔除口腔內(nèi)氣管導(dǎo)管的時(shí)間)、麻醉恢復(fù)室(PACU)停留時(shí)間,從病房監(jiān)護(hù)室轉(zhuǎn)到普通病房的時(shí)間(監(jiān)護(hù)病房停留時(shí)間);記錄在麻醉恢復(fù)室發(fā)生的不良事件,躁動(dòng)、嗜睡(困倦、應(yīng)對指令反應(yīng)緩慢遲鈍)、惡心嘔吐、皮膚瘙癢、呼吸抑制(Sp O2≤90%)等。結(jié)果:1、兩組患者的一般資料(年齡、ASA分級)比較,無統(tǒng)計(jì)學(xué)意義。2、在術(shù)中及蘇醒期各時(shí)間點(diǎn)T_0、T_1、T_2、T_3、T_4、T_5、T_6、T_7的平均動(dòng)脈壓、心率無明顯差異。3、地氟醚組患者在蘇醒時(shí)間、拔管時(shí)間、蘇醒室停留時(shí)間、從病房監(jiān)護(hù)室轉(zhuǎn)到普通病房的時(shí)間均短于七氟醚組(p0.05)。4、地氟醚組術(shù)后躁動(dòng)評分低于七氟醚組(p0.05)。5、術(shù)后在PACU發(fā)生嗜睡、呼吸抑制的例數(shù)地氟醚組低于七氟醚組(p0.05),惡心嘔吐和皮膚瘙癢的發(fā)生例數(shù)兩者無明顯差異。結(jié)論:在老年腹腔鏡結(jié)直腸癌根治術(shù)中,應(yīng)用地氟醚進(jìn)行術(shù)中麻醉維持,拔管時(shí)間和蘇醒時(shí)間縮短,可以提高蘇醒期的質(zhì)量和安全性、對麻醉恢復(fù)期的影響較小,同時(shí)也能夠有效地加快麻醉恢復(fù)室(PACU)和手術(shù)室的周轉(zhuǎn),提高工作效率,減少資源浪費(fèi)。在PACU患者的躁動(dòng)評分和不良事件發(fā)生例數(shù),地氟醚組均略低于七氟醚組。有利于老年患者術(shù)后恢復(fù)。由此可見,地氟醚可作為老年患者行腹腔鏡結(jié)直腸癌手術(shù)的麻醉方案,有利于老年患者蘇醒期的快速恢復(fù)。使ERAS這一理念在結(jié)直腸外科得以體現(xiàn)。
[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)鐨勫鉤鍧囧姩鑴夊帇MAP(mm Hg),蹇冪巼HR(嬈，

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