丙泊酚靶控輸注復(fù)合地氟烷吸入麻醉用于老年婦科腹腔鏡手術(shù)的效果
發(fā)布時(shí)間：2018-12-16 12:27
【摘要】：目的:觀察丙泊酚靶控輸注(TCI)復(fù)合地氟烷吸入麻醉維持用于老年婦科腹腔鏡手術(shù)患者的效果。方法:將90例擇期行老年婦科腹腔鏡手術(shù)的患者,采用隨機(jī)數(shù)字表法隨機(jī)分為P組:丙泊酚TCI,PD組:丙泊酚TCI復(fù)合地氟烷吸入和D組:地氟烷吸入,每組30例。麻醉誘導(dǎo),可視喉鏡下行氣管插管,接呼吸機(jī)行機(jī)械通氣。麻醉維持:P組丙泊酚血漿靶濃度3~4μg/ml,PD組在P組的基礎(chǔ)上復(fù)合吸入地氟烷2%~3%,D組吸入地氟烷5%~8%。標(biāo)記各組患者在入室時(shí)(T0)、氣管插管即刻(T1)、氣管插管后5min(T2)、二氧化碳?xì)飧菇⒓纯?T3)、氣腹建立后5min(T4)、氣腹建立后15min(T5)、氣腹建立后25min(T6)、氣管拔管即刻(T7)、氣管拔管后5min(T8)各時(shí)刻的血流動(dòng)力學(xué)參數(shù);采集T0和T8兩個(gè)時(shí)間點(diǎn)的靜脈血,測定血漿中T-AOC,SOD,GSH-Px,MDA和VE的值。記錄自主呼吸恢復(fù)時(shí)間、聽指令睜眼時(shí)間、拔管時(shí)間、蘇醒室(PACU)停留時(shí)間、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后惡心嘔吐(PONV)例數(shù)和躁動(dòng)例數(shù)。結(jié)果:1.一般資料及手術(shù)情況三組患者的平均年齡、平均體重、平均手術(shù)時(shí)間、術(shù)中出血量的中位數(shù)比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。2.圍術(shù)期血流動(dòng)力學(xué)改變在氣管插管即刻(T1)、氣腹即刻(T3)以及拔管(T7)時(shí),各組的MAP、HR與其相對應(yīng)的基礎(chǔ)值相比均有所增加,PD組在氣腹即刻(T3)、氣腹建立后5min(T4)、氣腹建立后15min(T5)時(shí)的MAP和在T3時(shí)的HR比P組在該時(shí)刻對應(yīng)值更低(P㩳0.05),與D組比較無差異(P0.05),但總體上三組均未發(fā)生嚴(yán)重血流動(dòng)力學(xué)改變。3.氧化應(yīng)激的結(jié)果P組在氣管拔管后5min(T8)的T-AOC值高于入室時(shí)(T0),差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05);D組在T8時(shí)的T-AOC和VE值低于T0,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05);余各值差異無統(tǒng)計(jì)意義。組間比較:在T8時(shí),P組的T-AOC值分別高于D組和PD組(P㩳0.05);余各值差異無統(tǒng)計(jì)意義。4.三組患者的早期恢復(fù)情況P組在聽指令睜眼時(shí)間和拔管時(shí)間上長于PD組和D組,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。5.術(shù)后惡心嘔吐與躁動(dòng)P組和PD組早期(PACU內(nèi))惡心嘔吐發(fā)生率(3.33%)低于D組(26.67%)(P㩳0.05),而三組在病房的PONV和躁動(dòng)發(fā)生率無明顯差異(P0.05)。結(jié)論:三種麻醉均可安全用于老年婦科腹腔鏡手術(shù),丙泊酚TCI復(fù)合地氟烷吸入的麻醉維持方法,術(shù)中血流動(dòng)力學(xué)更穩(wěn)定,圍術(shù)期氧化應(yīng)激影響小,術(shù)后早期恢復(fù)更快且惡心嘔吐發(fā)生率低。
[Abstract]:Objective: to observe the efficacy of target controlled infusion of propofol (TCI) combined with desflurane inhalation anesthesia in elderly patients undergoing gynecological laparoscopic surgery. Methods: ninety elderly patients undergoing laparoscopic gynecologic surgery were randomly divided into group P (n = 30): propofol TCI,PD group (n = 30), propofol TCI combined desflurane inhalation group (n = 30) and desflurane inhalation group (n = 30). Anesthesia induction, intubation under visual laryngoscope, mechanical ventilation by ventilator. Anesthesia maintenance: the plasma target concentration of propofol in group P was 3 ~ 4 渭 g 路ml ~ (-1) / d. On the basis of group P, desflurane _ 2 was inhaled and desflurane was inhaled in group D. At the time of entry (T 0), tracheal intubation (T 1), 5min (T 2) after tracheal intubation, carbon dioxide pneumoperitoneum (T 3), 5min (T 4) after pneumoperitoneum and 15min (T 5) after pneumoperitoneum were observed. The hemodynamic parameters of 25min (T6), immediate tracheal extubation (T7) and 5min (T8) after extubation of pneumoperitoneum were observed. The venous blood samples were collected at T0 and T8 time points to determine the levels of GSH-PxCX MDA and VE in plasma. The recovery time of spontaneous respiration, the time of opening eyes, the time of extubation, the staying time of (PACU) in the awake room, the time of operation, the amount of blood lost during operation, the (PONV) cases of nausea and vomiting after operation and the number of restlessness were recorded. Results: 1. There was no significant difference in average age, average body weight, mean operative time and median amount of intraoperative bleeding among the three groups (P0.05). The changes of hemodynamics in perioperative period were increased at the time of tracheal intubation (T1), pneumoperitoneum (T3) and extubation (T7). The MAP,HR of each group was increased compared with the corresponding basic values, and that of PD group was immediately after pneumoperitoneum (T3). The corresponding values of 5min (T4) after pneumoperitoneum, 15min (T5) after pneumoperitoneum and HR at T3 were lower than those in group P (P0. 05), but there was no difference between group D and group D (P0.05). But on the whole, no serious hemodynamic changes occurred in the three groups. The results of oxidative stress showed that the T-AOC value of 5min (T8) after extubation in group P was higher than that at the time of extubation (T0), and the difference was statistically significant (P0. 05). The values of T-AOC and VE in group D at T8 were lower than those in T0, the difference was statistically significant (P0. 05), but there was no statistical significance in other values. Comparison between groups: at T8, the T-AOC value of P group was higher than that of D group and PD group (P0. 05), and the other values had no statistical significance. 4. The early recovery in group P was longer than that in group PD and group D (P 0.05). The incidence of nausea and vomiting (3.33%) was lower than that in group D (26.67%) in group P and PD (P < 0.05), but there was no significant difference in PONV and restlessness among the three groups (P0.05). Conclusion: all three kinds of anesthesia can be safely used in laparoscopic surgery for elderly gynecological patients. Propofol TCI combined with desflurane inhalation can maintain anesthesia. The hemodynamics is more stable during operation, and the effect of oxidative stress on perioperative period is less than that of propofol TCI. Early postoperative recovery was faster and the incidence of nausea and vomiting was low.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614
本文編號(hào)：2382341
[Abstract]:Objective: to observe the efficacy of target controlled infusion of propofol (TCI) combined with desflurane inhalation anesthesia in elderly patients undergoing gynecological laparoscopic surgery. Methods: ninety elderly patients undergoing laparoscopic gynecologic surgery were randomly divided into group P (n = 30): propofol TCI,PD group (n = 30), propofol TCI combined desflurane inhalation group (n = 30) and desflurane inhalation group (n = 30). Anesthesia induction, intubation under visual laryngoscope, mechanical ventilation by ventilator. Anesthesia maintenance: the plasma target concentration of propofol in group P was 3 ~ 4 渭 g 路ml ~ (-1) / d. On the basis of group P, desflurane _ 2 was inhaled and desflurane was inhaled in group D. At the time of entry (T 0), tracheal intubation (T 1), 5min (T 2) after tracheal intubation, carbon dioxide pneumoperitoneum (T 3), 5min (T 4) after pneumoperitoneum and 15min (T 5) after pneumoperitoneum were observed. The hemodynamic parameters of 25min (T6), immediate tracheal extubation (T7) and 5min (T8) after extubation of pneumoperitoneum were observed. The venous blood samples were collected at T0 and T8 time points to determine the levels of GSH-PxCX MDA and VE in plasma. The recovery time of spontaneous respiration, the time of opening eyes, the time of extubation, the staying time of (PACU) in the awake room, the time of operation, the amount of blood lost during operation, the (PONV) cases of nausea and vomiting after operation and the number of restlessness were recorded. Results: 1. There was no significant difference in average age, average body weight, mean operative time and median amount of intraoperative bleeding among the three groups (P0.05). The changes of hemodynamics in perioperative period were increased at the time of tracheal intubation (T1), pneumoperitoneum (T3) and extubation (T7). The MAP,HR of each group was increased compared with the corresponding basic values, and that of PD group was immediately after pneumoperitoneum (T3). The corresponding values of 5min (T4) after pneumoperitoneum, 15min (T5) after pneumoperitoneum and HR at T3 were lower than those in group P (P0. 05), but there was no difference between group D and group D (P0.05). But on the whole, no serious hemodynamic changes occurred in the three groups. The results of oxidative stress showed that the T-AOC value of 5min (T8) after extubation in group P was higher than that at the time of extubation (T0), and the difference was statistically significant (P0. 05). The values of T-AOC and VE in group D at T8 were lower than those in T0, the difference was statistically significant (P0. 05), but there was no statistical significance in other values. Comparison between groups: at T8, the T-AOC value of P group was higher than that of D group and PD group (P0. 05), and the other values had no statistical significance. 4. The early recovery in group P was longer than that in group PD and group D (P 0.05). The incidence of nausea and vomiting (3.33%) was lower than that in group D (26.67%) in group P and PD (P < 0.05), but there was no significant difference in PONV and restlessness among the three groups (P0.05). Conclusion: all three kinds of anesthesia can be safely used in laparoscopic surgery for elderly gynecological patients. Propofol TCI combined with desflurane inhalation can maintain anesthesia. The hemodynamics is more stable during operation, and the effect of oxidative stress on perioperative period is less than that of propofol TCI. Early postoperative recovery was faster and the incidence of nausea and vomiting was low.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614
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