丙泊酚复合瑞芬太尼靶控输注用于老年胃癌根治术的临床观察

Clinical Observation on Application of Propofol Combined with Remifentanil Target-controlled Infusion to Radical Resection for Gastric Cancer in Elderly Patients

目的:探讨老年胃癌根治术中丙泊酚复合瑞芬太尼靶控输注的麻醉效果。方法:选取我院2015年2月—2017年2月收治的老年胃癌根治术患者96例,按随机数字表法分为对照组与观察组,各48例,两组麻醉前常规禁食、禁水,均给予丙泊酚复合瑞芬太尼麻醉。对照组采用持续静脉输注,观察组为靶控输注,比较两组麻醉诱导前(T0)、切皮时(T1)、手术结束时(T2)、拔管时(T3)的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)水平,记录术后苏醒时间、拔管时间以及自主意识、吞咽功能恢复时间,通过采血检测T0、T2、术后48 h(T4)的免疫功能指标(CD4^+、CD4^+/CD8+),并观察麻醉药物的不良反应。结果:两组T1、T2时SBP、DBP、HR、SpO2均低于T0,且观察组HR、SpO2高于对照组,差异有统计学意义(P<0.05);观察组拔管、自主意识恢复、吞咽功能恢复时间均短于对照组,差异有统计学意义(P<0.05);两组T2时CD4^+、CD8+、CD4^+/CD8+均低于T0,观察组T2、T4的CD4^+/CD8+高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:老年胃癌根治术患者采用丙泊酚复合瑞芬太尼靶控输注麻醉,能提高麻醉过程中心率、血氧饱和度稳定性,缩短拔管时间,促进自主意识、吞咽功能、免疫功能恢复,且安全性高,值得临床推广。

Objective:To investigate the anesthetic effect of propofol combined with remifentanil targetcontrolled infusion in elderly patients undergoing radical resection for gastric cancer.Methods:96 elderly patients undergoing radical resection for gastric cancer admitted to our hospital from February 2015 to February 2017 were selected and randomly divided into a control group and an observation group,48 cases each.Routine fasting and water fasting before anesthesia were given to the patients in the two groups,and the patients in the two groups were anaesthetized with propofol combined with remifentanil.The patients in the control group received continuous intravenous infusion,and the patients in the observation group received target-controlled infusion.The levels of systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),blood oxygen saturation(SpO2)before anesthesia induction(T0),at the time of cutting(T1),at the end of surgery(T2)and at the time of extubation(T3)were compared between the two groups.The postoperative awakening time,extubation time and autonomic awareness and swallowing function recovery time were recorded.Immune function indexes(CD4^+,CD4^+/CD8+)at T0,T2 and 48 h(T4)after operation were detected by blood sampling,and the adverse reactions of anesthetics were observed.Results:The levels of SBP,DBP,HR and SpO2 at T1 and T2 were lower than those at T0 in the two groups,and the levels of HR and SpO2 in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).The time of extubation and the time of autonomous consciousness recovery and swallowing function recovery in the observation group were shorter than those in the control group,with statistically significant differences(P<0.05).The levels of CD4^+,CD8+and CD4^+/CD8+at T2 were lower than those at T0 in the two groups,and the levels of CD4^+/CD8+at T2 and T4 in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Target-controlled infusion anesthesia with propofol and remifentanil can improve the stability of heart rate and oxygen saturation during anesthesia,shorten the extubation time and promote the recovery of autonomous consciousness,swallowing function and immune function in the elderly patients undergoing radical resection for gastric cancer,which is safe and worthy of clinical promotion.