【摘要】 目的观察舒芬太尼、芬太尼联合丙泊酚持续静脉输注在食管癌根治术中的麻醉效果。方法食管癌手术患者84例,ASAⅠ～Ⅱ级,42～78岁;随机分为两组:芬太尼组(F组)和舒芬太尼组(S组),每组42例。全麻维持,F组采用芬太尼3μg/(kg.h)和丙泊酚4mg/(kg.h)持续静脉输注,S组采用舒芬太尼0.3μg/(kg.h)和丙泊酚4mg/(kg.h)持续静脉输注。记录诱导前(T0)、气管插管前(T1)、气管插管后即刻(T2)、切皮时(T3)、撑开胸廓时(T4)、游离食管时(T5)、拔管时(T6)平均动脉压(MAP)和心率(HR);记录麻醉结束至自主呼吸恢复时间、完全清醒时间(OAAS评分为5分)以及感觉疼痛(视觉模拟评分VAS≥3分)时间;观察并记录患者躁动、恶心、呕吐、术中知晓发生情况。结果①S组T1、T2、T3、T4、T5、T6时间点MAP和HR均低于诱导前(T0)基础值P<0.05,诱导后各个时间点无统计学差异;②F组T2、T3、T4、T5、T6时间点MAP和HR均高于诱导前(T0)基础值及气管插管前(T1),P<0.05;S组在T2、T3、T4、T5、T6时间点MAP与HR低于F组,P<0.05;③S组自主呼吸恢复时间、完全清醒时间、感觉疼痛时间均长于F组,P<0.05;④两组无术中知晓;S组术后苏醒时躁动发生低于F组,P<0.05;两组术后恶心、呕吐发生情况无统计学意义。结论持续泵注舒芬太尼和丙泊酚能为食管癌根治术提供血流动力学稳定、患者苏醒平稳的麻醉效果。更多还原

【Abstract】 Objective To observe efficacy of sufentanil or fentanyl when combined with propofol on patients undergoing esophageal carcinoma surgery.Methods The 84 ASA I or II patients aged 42~78yr weighing 40~80kg undergoing esophageal carcinoma surgery were randomly divided into two groups(n=42 each):S group(sufentanil group) and F group(fentanyl group).S group received sufentanil 0.3μg/(kg·h) and propofol 4mg/(kg·h) by continuously intravenous infusion.F group received fentanyl 3μg/(kg·h) and propofol 4mg/(kg·h) by continuously intravenous infusion.The mean artery pressure(MAP) and heart rate(HR) were recorded before induction(T0),before and after inintubation(T1 and T2),incision(T3),thoracomy(T4),dissociation of esophagus(T5) and extubation(T6).The time of respiratory recovery,conscious recovery and postoperative pain were recorded;The incidences of awakeness during surgery,agitation and postoperative nausea and vomiting were recorded.Results In S group,the MAP and HR of T1,T2,T3,T4,T5 and T6 were significantly lower T0;In F group,the MAP and HR of T2,T3,T4,T5 and T6 were significantly higher T0 and T1;the MAP and HR of T2,T3,T4,T5 and T6 in F group were significantly higher than in S group.The time of respiratory recovery,conscious recovery and postoperative pain in S group were significantly longer than in F group(P<0.05).The incidence of agitation in S group was significantly higher than F group.Conclusion The combination of sufenanil with propofol can provide stabile hemodynamics and conscious recovery for esophageal carcinoma surgery by continuous intravenous infusion.更多还原