【摘要】：目的：對我院148例腎移植病人的麻醉記錄資料回顧分析，總結(jié)分析靜吸復合麻醉和靜脈麻醉對腎移植手術(shù)患者的血流動力學變化、麻醉蘇醒情況、及預后等多方面的資料，探討麻醉對腎移植病人的影響及麻醉管理的要點。 麻醉方法：148例患者均選用喉罩全身麻醉，按麻醉方案不同分為靜吸復合麻醉A組（81）例和靜脈麻醉B組（67例），病人入室后常規(guī)行橈動脈穿刺，監(jiān)測有創(chuàng)血壓、心電、脈膊血氧飽和度，，麻醉后行右頸內(nèi)靜脈穿刺監(jiān)測CVP。兩組麻醉誘導均依次經(jīng)靜脈緩慢注射咪達唑侖0.03-0.04mg/kg,舒芬太尼0.3-0.4μg/kg，苯磺酸順阿曲庫銨0.15mg/kg，依托咪酯0.3-0.4mg/kg。Ⅰ組麻醉維持使用1%~2%七氟烷、丙泊酚4-8mg/kg·h和瑞芬太尼0.1-0.2μg/kg·min持續(xù)泵入。Ⅱ組麻醉維持使用丙泊酚丙泊酚6-10mg/kg·h和瑞芬太尼0.1-0.2μg/kg·min持續(xù)泵入。兩組患者誘導成功后插入喉罩(supreme)，行機械通氣，設定氧流量2L/min，潮氣量6-12ml/kg，呼吸頻率10-14次/min，吸呼比I:E=1:2，,呼氣末二氧化碳分壓維持在28-45mmHg。I組手術(shù)結(jié)束前30min停止吸入七氟烷，手術(shù)結(jié)束前l(fā)0min停止泵入丙泊酚，手術(shù)結(jié)束前5min停止泵入瑞芬太尼；T組手術(shù)結(jié)束前l(fā)0min停止泵入丙泊酚，手術(shù)結(jié)束前5min停止泵入瑞芬太尼。待患者意識清醒，肌力恢復良好，呼吸平穩(wěn)，Sp0295％時拔出喉罩，送監(jiān)護室繼續(xù)觀察治療。 觀測指標： （1）血流動力學指標:監(jiān)測記錄患者麻醉前(T1)、腎血流開放前(T2)、腎血流開放后l0min (T3)、手術(shù)結(jié)束時(T4)的MAP、CVP、HR值； （2）圍術(shù)期并發(fā)癥情況 （3）蘇醒時間； （4）預后情況。 結(jié)果：兩組病人MAP在腎血流開放后10min（T3）比麻醉前（T1）、開放前（T2）降低(P0．05)，但A組患者的MAP波動與B組患者相比明顯較小。兩組病人T3的CVP明顯較T2下降(P0．05)，且A組患者的MAP波動更小。兩組患者T3的HR較T2無統(tǒng)計學差異(P0．05)。 結(jié)論：靜吸復合麻醉在腎移植手術(shù)中較靜脈麻醉更易在移植腎血流開放前后控制血壓，減少蘇醒時間，并且能減少靜脈麻醉藥物的用量，降低對肝、腎的影響。
[Abstract]:Objective: to retrospectively analyze the anesthetic records of 148 cases of renal transplantation in our hospital, and summarize and analyze the hemodynamic changes, anaesthesia recovery and prognosis of patients undergoing renal transplantation under combined intravenous anesthesia and intravenous anesthesia. To explore the effect of anesthesia on renal transplantation patients and the key points of anesthesia management. Methods: 148 patients were divided into group A (81 cases) and group B (67 cases) according to different anesthetic schemes. The patients underwent radial artery puncture after entering the room to monitor invasive blood pressure and electrocardiogram (ECG), the patients were divided into two groups: group A (n = 81) and group B (n = 67). Pulse oxygen saturation, right internal jugular vein puncture after anesthesia to monitor CVP. Midazolam 0.03-0.04 mg / kg, sufentanil 0.3-0.4 渭 g / kg, sulfentanil 0.15 mg / kg, etomidate 0.3-0.4 mg / kg respectively. Propofol 4-8mg/kg h and remifentanil 0.1-0.2 渭 g/kg min were continuously pumped in group 鈪

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