瑞芬太尼复合丙泊酚靶控输注麻醉用于肝部分切除术患者临床效果研究*

doi:10.3969/j.issn.1672-5069.2020.02.031

摘要/Abstract

摘要： 目的探讨瑞苏太尼复合丙泊酚靶控输注(TCI)麻醉用于肝脏部分切除术(PHX)患者的麻醉效果。方法 2017年4月～2019年1月我院行PHX的原发性肝癌(PLC)患者86例,随机将患者分为研究组43例和对照组43例,给予对照组患者常规麻醉,给予研究组瑞芬太尼复合丙泊酚TCI麻醉,评价苏醒室标准(Aldrete)和改良警觉-镇静量表(OAA/S)评分。结果研究组患者拔管时间为(12.7±3.3)min,呼之睁眼时间为(10.1±3.2)min,自主呼吸恢复时间为(9.4±2.1)min,均显著短于对照组【分别为(18.4±5.2)min、(17.6±3.4)min和(16.4±5.4)min,P<0.05】;在T0时,两组应激反应指标比较无显著性差异(P>0.05),但术中研究组应激反应指标水平整体优于对照组(P<0.05);拔管后即刻和拔管后15min,研究组患者Aldrete评分分别为(9.4±0.7)分和(9.4±0.8)分,OAA/S评分分别为(4.3±0.4)分和(4.7±0.4)分,显著高于对照组【分别为(8.3±0.4)分和(8.9±0.5)分,和(3.4±0.4)分和(4.2±0.5)分,P<0.05】;研究组不良反应发生率为11.6%,显著低于对照组的27.9%(P<0.05)。结论应用瑞苏太尼复合丙泊酚TCI麻醉应用于PHX手术可有效减轻术中应激反应,提高术后苏醒效果,且具有较高的安全性,值得临床验证。

关键词: 原发性肝癌, 肝脏部分切除术, 瑞芬太尼, 丙泊酚, 靶控输注, 麻醉

Abstract: Objective The aim of this study was to investigate the anesthetic efficacy of target-controlled infusion of (TCI) in accordance with propofol in partial hepatectomy. Methods Eighty-six patients with primary liver cancer (PLC) undergoing partial hepatectomy in our hospital between April 2017 and January 2019 were randomly divided into study group and control group with 43 in each. The patients in the control group were given routine anesthesia and those in the study group were anesthetized with remifentanil combined with propofol at the manner of TCI. The extubation time, eye opening time, spontaneous respiratory recovery time, stress response index and standard for coming out of the awakening room (Aldrete) were compared between the two groups. Modified vigilance sedation scale (OAA/S) score was obtained and the complications between the two groups were compared. Results The extubation time, the eye opening time and spontaneous respiratory recovery time in patients in the study group were significantly shorter than those in the control group [(12.7±3.3) min, (10.1±3.2)min and (9.4±2.1)min, vs. (18.4±5.2)min, (17.6±3.4)min and (16.4±5.4)min, respectively, P<0.05】; there was no significant difference in stress response index between the two groups at T0 (P > 0.05), while the level of stress response index in the study group was better thanthat in the control group (P < 0.05) during the operation; immediately after extubation and 15 minutes after extubation, the Aldrete scores in the study group were (9.4±0.7) and (9.4±0.8), and the OAA/S scores were (4.3±0.4) and (4.7±0.4), significantly higher than [(8.3±0.4) and (8.9±0.5), and (3.4±0.4) and (4.2±0.5), respectively, P<0.05】 in the control; the incidence of adverse reactions in the study group was 11.6%, significantly lower than 27.9% in the control (P < 0.05). Conclusion The application of the compound propofol TCI anesthesia is appropriately applied to the partial hepatectomy, and the stress reaction during the operation could be effectively reduced, which might improve the recovery of patients with PLC after operation.

Key words: Hepatoma, Partial hepatectomy, Remifentanil, Propofol, Target-controlled infusion, Anesthesia

李颖, 黄海清, 薛富善, 池萍, 李丽. 瑞芬太尼复合丙泊酚靶控输注麻醉用于肝部分切除术患者临床效果研究^*[J]. 实用肝脏病杂志, 2020, 23(2): 272-275.

Li Ying, Huang Haiqing, Xue Fushan, et al. Clinical observation of remifentanil combined with propofol target-controlled infusion anesthesia in patients with primary liver cancer underwent partial hepatectomy[J]. Journal of Practical Hepatology, 2020, 23(2): 272-275.

参考文献

[1] Forget P, DeKock M. Perspectives in anaesthesia for cancer surgery. J Cancer Res Clin Oncol, 2014 , 140(3): 353-359.
[2] Khasag N, Sakiyama S, Toba H, et a1.Monitoring of exhaled carbon monoxide and carbon dioxide during lung cancer operation. Eur J Cardiothorac Surg, 2014 ,45(3): 531-536.
[3] Muhly W, Gurnaney H, Hosalkar H, et a1. Continuous peri-neural infusion after lower extremity osteotomies in children: A feasibility and safety analysis. Br J Anaesth, 2013, 110(5):851-852.
[4] Kim M, Ishioka S, Endo T, et al. Obstetrical prognosis of patients with cervical intraepithelial neoplasia (cin) after "coinshaped" conization. Arch Gynecol Obstet, 2016, 293(3):651-657.
[5] 陈淼,韩雪萍,尚学栋,等.右美托咪定对颈内动脉球囊闭塞试验患者术中唤醒试验质量的影响.中华麻醉学杂志,2017, 37(5):601-605.
[6] 中国抗癌协会肝癌专业委员会.原发性肝癌诊断标准.中华肝脏病杂志,2000, 8(3):135.
[7] 刘丽丽, 王涛, 徐志新, 等. 丙泊酚与七氟烷麻醉对肝切除术患者术后炎症因子和肝脏功能的影响比较. 中国生化药物杂志, 2015, 35(9): 82-84.
[8] Nicholson BD. Economic and clinical burden of opioidinduced nausea and vomiting.Postgrad Med, 2017,129(1): 111-117.
[9] Gentry KR, Steele LM, Sedensky MM, et al. Early developmental exposure tovolatile anesthetics causes behavioral defects in Caenorhabditis elegans. Anesth Analg, 2013,116(1):185.
[10] Scott HB, Choi SW, Wong GT, et a1. The effect of remifentanil on propofol requirements to achieve 10ss of response to command VS. 10ss of response to pain lJJ.Anaesthesia, 2017,72(4): 479-487.
[10] Park KY, Hwang HS, Kim YP, et al. Risk factors for cognitive decline associated with gait speed in communitydwelling elderly Koreans with MMSE scores of 30. Aging Clin Exp Res, 2017, 29(2): 183-189.
[11] Matushita S, Oda S, Otaki K, et al. Change in auditory evoked potential index and bispectral index during induction of anesthesia with anesthetic drugs. J Clin Monit Comput, 2015, 29(5): 1-6.
[12] Wang X, Wang T, Tian Z, et a1. Asleep-awake-asleep regimen for epilepsy surgery:A prospective study of target-controlled infusion versus manually controlled infusion technique. J Clin Anesth, 2016, 32: 92-100.
[13] Acmaz G, Bayraktar E, Aksoy H, et al. Effect of paracetamol, dexketoprofen trometamol, lidocaine spray,pethidine and diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial. Indian J Med Res, 2015, 142(4): 399-404.
[14] Gan TJ, Meyer TA, Apfel CC, et al. Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting. Ambulat Anesthesiol, 2015, 105(6):1615 -1628.
[15] 王华.不同麻醉方式对骨折合并高血压的老年患者围术期血管弹性、血流动力学以及认知功能的影响.中国临床医生杂志,2018, 46(5):565-568.
[16] Gupta A, Stierer T, Zuckerman, et al. Comparison of recovery profile after ambulatory anesthesia with propofol isoflurane sevoflurane and desfluranera systematic review. Anesth Analg, 2015, 98(3): 632-641.
[17] Wigmore T J, Mohammed K, Jhanji S. Long-term survival for patients undergoing volatile versus 1V anesthesia for cancer surgery: a retrospective analysis. Anesthesiology, 2016,124(1): 69-79.
[18] Kim R. EIkcts of surgery and anesthetic choice on immuno-suppression and cancer recurrence. J Transl Med,2018,16(1):8.
[19] Lai Y, Wang X, Zeng T, et a1. Serum VEGF levels in the earlydiagnosis and severity assessment of non-small cell lung cancer. J Cancer, 2018, 9(9): 1538-1547.
[20] 李柳旬,徐波,吴宗泽,等.NI指导下丙泊酚-瑞芬太尼程控性闭环靶控输注麻醉用于腹腔镜胆囊切除术的效果.中华麻醉学杂志, 2016, 36(12): 1423-1427.

瑞芬太尼复合丙泊酚靶控输注麻醉用于肝部分切除术患者临床效果研究^*

Clinical observation of remifentanil combined with propofol target-controlled infusion anesthesia in patients with primary liver cancer underwent partial hepatectomy

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	陈亮, 段海峰, 余红星. SMI、CDFI和增强CT检查TACE术治疗的原发性肝癌患者癌组织血供显像效果比较^*[J]. 实用肝脏病杂志, 2020, 23(1): 90-93.
[2]	马宁, 戴晓雯, 吴建江. 肝部分切除术患者目标导向性液体治疗疗效及安全性研究^*[J]. 实用肝脏病杂志, 2020, 23(1): 102-105.
[3]	金震, 周晓春, 马红霞. 椎旁阻滞联合全身麻醉对肝血管瘤切除术患者疼痛及术后恢复的影响^*[J]. 实用肝脏病杂志, 2019, 22(6): 908-911.
[4]	邢昊, 韩骏, 杨田. 应用血清PIVKA-II诊断肝细胞癌研究进展^*[J]. 实用肝脏病杂志, 2019, 22(6): 934-937.
[5]	石小龙, 杜睿, 秦革萍, 薛华燕, 张宏鑫. 七氟醚对脓毒症大鼠肝损伤的保护作用及其作用机制研究*[J]. 实用肝脏病杂志, 2019, 22(5): 640-643.
[6]	刘杏, 赵树立, 张殿隆. 七氟烷吸入时机对肝脏部分切除术患者肝脏缺血再灌注损伤的影响*[J]. 实用肝脏病杂志, 2019, 22(5): 728-731.
[7]	崔发强, 李涛, 王铮, 陈青. 原发性肝癌患者外周血KRAS基因水平及其对西妥昔单克隆抗体治疗疗效的影响[J]. 实用肝脏病杂志, 2019, 22(4): 565-568.
[8]	赵晓光, 史玉洁. 应用还原型谷胱甘肽预防处理接受TACE治疗的中晚期原发性肝癌患者对肝功能的影响[J]. 实用肝脏病杂志, 2019, 22(3): 425-428.
[9]	李克田,沈明格,王凤荣,胡春荣,曹玉杰,芦鹏. 血糖水平对原发性肝癌患者¹⁸F-FDG摄取和PET/CT检查图像质量的影响研究^*[J]. 实用肝脏病杂志, 2019, 22(2): 256-259.
[10]	张帮健,魏寿存,杨小燕. 右美托咪啶联合丙泊酚麻醉对肝癌切除术患者围手术期血清细胞因子和术后苏醒质量的影响 ^*[J]. 实用肝脏病杂志, 2019, 22(2): 264-267.
[11]	王翠晓, 高静. 血清高尔基蛋白73、甲胎蛋白异质体3、甲胎蛋白和α-L-岩藻糖苷酶水平诊断原发性肝癌的效能分析^*[J]. 实用肝脏病杂志, 2019, 22(1): 113-116.
[12]	陈向, 汪宝林, 吴琛, 唐劲草, 张弛, 褚朝顺. 动脉灌注化疗栓塞联合放射粒子植入治疗原发性肝癌患者疗效及其对肝组织TRF1和TRF2表达的影响^*[J]. 实用肝脏病杂志, 2019, 22(1): 121-124.
[13]	闫书鸣, 王建国, 李泽信, 游焜, 王亮, 郭鹏威. 门冬氨酸鸟氨酸治疗肝癌切除术患者对肝脏缺血再灌注损伤的保护作用研究^*[J]. 实用肝脏病杂志, 2018, 21(6): 932-935.
[14]	汪华, 赵亚宁. 索拉菲尼治疗进展期原发性肝癌患者有效性及安全性研究^*[J]. 实用肝脏病杂志, 2018, 21(6): 936-939.
[15]	杨学民, 李朝路, 李兆阳. microRNA194过表达抑制荷瘤小鼠肝癌细胞生长的实验研究^*[J]. 实用肝脏病杂志, 2018, 21(5): 705-708.