微创医学

目的比较瑞芬太尼复合丙泊酚或七氟醚两种快通道麻醉方法用于老年腹腔镜结直肠肿瘤手术时血流动力学的变化以及术后复苏的情况。方法选择拟在腹腔镜下行结直肠肿瘤手术的老年病人60例,随机分为2组,瑞芬太尼复合丙泊酚组(快通道P组)和瑞芬太尼复合七氟醚组(快通道F组),各30例。两组患者都记录麻醉前基础值(t0)、插管后即刻(t1)、插管后10 min(t2)、气腹时(t3)、气腹后30 min(t4)、手术结束时(t5)以及拔管即刻时(t6)的血压和心率,并记录停用所有麻醉药至病人睁眼时间、自主呼吸恢复时间、气管导管被拔出时间及定向力恢复时间,记录患者术后恶心、呕吐、躁动发生率、血氧饱和度降低情况以及术中知晓的情况。结果①t2、t3时点快通道F组MAP与HR均比快通道P组低,在其余时间点两组比较无明显差异。②术后恢复自主呼吸的时间、睁眼时间、拔除气管导管的时间快通道F组均较快通道P组短,但定向力恢复时间较P组稍延长且两组比较差异无统计学意义。③快通道P组与快通道F组拔管后血氧饱和度降低(SpO2<90%),苏醒期躁动、呼吸困难发生情况比较无显著差异;而快通道F组术后恶心呕吐发生率明显高于快通道P组(P<0.05),术中两组均无知晓。结论瑞芬太尼复合丙泊酚或七氟醚两种快通道麻醉方法用于老年腹腔镜手术各有利弊,均可应用于老年腹腔镜结直肠肿瘤手术。

Objective To compare the hemodynamic changes during operation and resuscitation after operation of two fast track anesthesia: propofol or sevoflurane combined with remifentanil in colorectal cancer surgery with laparoscope in old adults． Method 60 elder patients scheduled for colorectal cancer surgery with laparoscope were selected and randomized into 2 groups，and each group has 30 patients． The objects in group P were received fast tract anesthesia with propofol and remifentanil． The patients in group F were undergone fast tract anesthesia with sevoflurane and remifentanil． Heart rate and blood pressure at different time points of t0( base values) ， t1( complete intubation immediately) ，t2 ( 10 min after intubation ) ，t3 ( beginning of artifical pneumoperitoneum) ， t4( 30 min after the beginning of artifical pneumoperitoneum ) ， t5 ( the operation was completed) and t6( extubation) in each group were recorded respectively． And time spans between ceasing administration of anesthetic and recovery，restoring spontaneous breathing，drawing out endotracheal catheter，and restoring orientation were recorded． Besides，post nausea，vomit，restlessness，change in SpO2 ，and awareness during operation were also observed． Results 1． The HR and MAP were lower in group P than those in group F at t2 and t3． 2． Time spans between ceasing administration of anesthetic and recovery，restoring spontaneous breathing，and drawing out endotracheal catheter were all shorter in group F than in group P． The restoration of orientation in group F delayed a little than in group P，but with no statistical significance． 3． SpO2 decreased in both groups，and there was no significant difference in restlessness or breath difficulty during analepsia between the two groups． Ratio of nausea and vomit in group F was much higher than in group P． No awareness during operation was reported in both groups． Conclusion With its own advantage and disadvantage，both propofol and sevoflurane can be safely administrated in fast tract anesthesia in colorectal cancer surgery with laparoscopy in elder patients．