發(fā)布時(shí)間：2018-09-08 10:25

【摘要】：目的：對(duì)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(fù)合麻醉和靜脈麻醉對(duì)腎移植手術(shù)患者的血流動(dòng)力學(xué)變化、麻醉蘇醒情況、及預(yù)后等多方面的資料，探討麻醉對(duì)腎移植病人的影響及麻醉管理的要點(diǎn)。 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(fù)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(dòng)脈穿刺，監(jiān)測(cè)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(cè)CVP。兩組麻醉誘導(dǎo)均依次經(jīng)靜脈緩慢注射咪達(dá)唑侖0.03-0.04mg/kg,舒芬太尼0.3-0.4μg/kg，苯磺酸順阿曲庫(kù)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(dǎo)成功后插入喉罩(supreme)，行機(jī)械通氣，設(shè)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(shí)清醒，肌力恢復(fù)良好，呼吸平穩(wěn)，Sp0295％時(shí)拔出喉罩，送監(jiān)護(hù)室繼續(xù)觀察治療。 觀測(cè)指標(biāo)： （1）血流動(dòng)力學(xué)指標(biāo):監(jiān)測(cè)記錄患者麻醉前(T1)、腎血流開(kāi)放前(T2)、腎血流開(kāi)放后l0min (T3)、手術(shù)結(jié)束時(shí)(T4)的MAP、CVP、HR值； （2）圍術(shù)期并發(fā)癥情況 （3）蘇醒時(shí)間； （4）預(yù)后情況。 結(jié)果：兩組病人MAP在腎血流開(kāi)放后10min（T3）比麻醉前（T1）、開(kāi)放前（T2）降低(P0．05)，但A組患者的MAP波動(dòng)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(dòng)更小。兩組患者T3的HR較T2無(wú)統(tǒng)計(jì)學(xué)差異(P0．05)。 結(jié)論：靜吸復(fù)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(kāi)放前后控制血壓，減少蘇醒時(shí)間，并且能減少靜脈麻醉藥物的用量，降低對(duì)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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