七氟醚联合丙泊酚静-吸复合麻醉用于原发性肝癌根治术治疗经验介绍*

doi:10.3969/j.issn.1672-5069.2022.05.024

摘要/Abstract

摘要： 目的探讨不同剂量七氟醚复合丙泊酚静-吸复合麻醉用于原发性肝癌(PLC)根治术的价值。方法 2019年11月～2021年11月我院诊治的110例PLC患者,均接受肝叶切除术。在麻醉时,患者被分为A组(n=54)和B组(n=56),A组以0.5肺泡最小有效浓度(MAC)七氟醚复合丙泊酚静-吸复合麻醉,B组以1.0 MAC七氟醚复合丙泊酚静-吸复合麻醉。进行Ramsay镇静、Aldrete评分和简易精神状态检查量表(MMSE)评分,术中监测心律(HR)、平均动脉压(MAP)和血氧饱和度(SpO₂)。结果在拔管后即刻,B组Ramsay镇静评分为(4.2±0.5)分,显著高于A组【(3.7±0.4)分,P＜0.05】,在拔管后15 min和30 min,两组Ramsay评分和Aldrete评分无显著性差异(P>0.05);在术后6 h、24 h和72 h时,B组MMSE评分分别为(25.7±2.8)分、(27.6±1.4)分和(28.4±1.1)分,均显著高于A组【分别为(22.2±3.6)分、(25.4±2.2)分和(27.8±1.2)分,P＜0.05】;术中B组HR为(79.5±11.6)次/min,显著快于A组【(74.1±12.4)次/min,P＜0.05】,但两组麻醉诱导前和术后6 h时HR比较无显著性差异(P＞0.05),两组围术期MAP和SpO₂比较无显著性差异(P＞0.05);B组不良反应发生率为23.2%,显著高于A组的7.4%(P＜0.05)。结论七氟醚复合丙泊酚静-吸复合麻醉应用于PLC患者根治性手术具有较好的麻醉效果。相对于小剂量的七氟醚,应用大剂量的七氟醚可获得更好的术后苏醒质量,更有利于术后神志的恢复,但也会出现不良反应增多的现象。因此,在选择七氟醚药物浓度时,应当及时评估患者麻醉风险,慎重作出决定。

关键词: 原发性肝癌, 肝叶切除术, 七氟醚, 丙泊酚, 静-吸复合麻醉

Abstract: Objective The aim of this study was to investigate different dosage of sevoflurane and propofol combination venous-inhalation anesthesia in patients with primary liver cancer (PLC) undergoing radical hepatectomy. Methods A total of 110 patients with PLC were recruited in our hospital between November 2019 and November 2021, and all underwent radical hepatectomy. During anesthesia, the patients were divided into group A (n=54) and group B (n=56), receiving 0.5 minimum alveolar concentration (MAC) or 1.0 MAC sevoflurane and propofol combination intravenous- inhalation anesthesia. The Ramsay sedation, Aldrete scores and mini-mental state examination (MMSE) scores were evaluated. The heart rhythm (HR), mean arterial pressure (MAP) and peripheral oxygen saturation (SpO₂) were recorded. Results The Ramsay sedation scores in group B immediately after extubation was (4.2±0.5), significantly higher than[(3.7±0.4), P＜0.05] in group A, while 5 minutes and 30 minutes after extubation, there were no significant differences respect to Ramsay and Aldrete scores between the two groups (P>0.05); at 6 h, 24 h and 72 h after operation, the MMSE scores in group B were (25.7±2.8), (27.6±1.4) and (28.4±1.1), all significantly higher than[(22.2±3.6), (25.4±2.2) and (27.8±1.2), respectively, P＜0.05] in group A; during operation, the HR in group B was (79.5±11.6)beats/min, faster than[(74.1±12.4)beats/min, P＜0.05] in group A, while before induction of and 6 hr after anesthesia, there were no significant differences respect to the HR, MAP and SpO₂ between the two groups (P＞0.05); the total incidence of adverse reactions in group B was (23.2%, much higher than 7.4%(P＜0.05) in group A. Conclusion The sevoflurane and propofol combination venous-inhalation anesthesia has a good anesthetic effect in the radical surgery of patients with PLC, and as compared with small dose, the administration of large dose of sevoflurane could obtain a better postoperative consciousness recovery, with a little more untoward reactions, which should be carefully evaluated before the operation.

Key words: Hepatoma, Hepatectomy, Sevoflurane, Propofol, Venous-inhalation anesthesia

樊顺克, 王贵罗, 伊晓燕. 七氟醚联合丙泊酚静-吸复合麻醉用于原发性肝癌根治术治疗经验介绍^*[J]. 实用肝脏病杂志, 2022, 25(5): 702-705.

Fan Shunke, Wang Guiluo,Yi Xiaoyan. Different dosage of sevoflurane and propofol combination venous-inhalation anesthesia in patients with primary liver cancer undergoing radical hepatectomy[J]. Journal of Practical Hepatology, 2022, 25(5): 702-705.

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七氟醚联合丙泊酚静-吸复合麻醉用于原发性肝癌根治术治疗经验介绍^*

Different dosage of sevoflurane and propofol combination venous-inhalation anesthesia in patients with primary liver cancer undergoing radical hepatectomy

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