胸腔镜胸交感神经切断术病人舒芬太尼复合异丙酚麻醉的效果

Efficacy of sufentanil combined with propofol for video-assisted endoscopic transthoracic sympathectom

目的评价胸腔镜胸交感神经切断术病人舒芬太尼复合异丙酚麻醉的效果。方法择期行胸腔镜胸交感神经切断术的手汗症病人20例，ASA Ⅰ或Ⅱ级，静脉注射舒芬太尼0．5μg／kg、异丙酚2．0～2．5mg／kg和阿曲库铵0．6mg／kg麻醉诱导，麻醉维持：静脉输注舒芬太尼0．2～0．3μg·kg^-1·h^-1、异丙酚2～4mg·kg^-1·h^-1，间断静脉注射阿曲库铵0．3mg／kg。手术结束前30min舒芬太尼输注速率减至0．1μg·kg^-1·h^-1，异丙酚减至1～2mg·kg^-1·h^-1。分别于麻醉诱导前（基础状态）、气管插管时、CO2充气时、CO2充气5min、30min、放气后5min、拔管时记录SP、DP、HR，并于上述时点采集静脉血样，测定血浆皮质醇、醛固酮和血糖浓度，记录自主呼吸恢复时间、呼之睁眼时间和拔管时间。结果术中SP、DP和HR波动在正常范围内；与基础值比较，血浆皮质醇、醛固酮和血糖浓度升高（P〈0．05），自主呼吸恢复时间、呼之睁眼时间和拔管时间分别为4．5±1．9、6．4±2．7、（12．6±1．5）min。结论胸腔镜胸交感神经切断术病人舒芬太尼0．1～0．3μg·kg^-1·h^-1。复合异丙酚1～4mg·kg^-1·h^-1。麻醉能维持血液动力学的稳定，可减轻应激反应。

Objective To evaluate the efficacy of sufentanil combined with propofol for Video-assisted endoscopic transthoracic sympathectomy. Methods Twenty ASA Ⅰ or Ⅱ patients of both sexes aged 17-40 yr weighing 52-75 kg undergoing video-assisted endoscopic transthoracic sympathectomy were enrolled in this study. Anesthesia was induced with propofol 2.0-2.5 mg/kg and sufentanil 0.5 μg/kg. Tracheal intubation was facilitated with atracurium 0.6 mg/kg. The patients were mechanically ventilated （VT = 8-10 ml/kg, RR = 10-12 bpm, I：E = 1 ： 2, FiO2 = 80% ）. Anesthesia was maintained with infusion of propofol 2-4 mg·kg^-1. h^-1 and sufentanil 0.2- 0.3μg·kg^-1. h^-1 and intermittent iv boluses of atracurium. At the 30 min before the end of operation propofol infusion was reduced to 1-2 mg·kg^-1·h^-1 and sufentanil infusion to 0.1 μg·kg^-1·h^-1 .BP （SP, DP） and HR were recorded and venous blood samples were taken before induction of anesthesia （baseline）, at tracheal intubation at the moment of CO2 insufflation 10 min and 30 min after CO2 insufflation, 5 min after deflation and at extubation for determination of plasma corticosteroid, aldosterone and glucose levels. The duration from termination of infusion of the anesthetics to recovery of spontaneous breathing, eye opening at command and tracheal extubation were recorded. Results SP, DP and HR were within the normal range. Plasma levels of corticosteroid, aldosterone and blood glucose were significantly increased during operation as compared with the baseline values. The duration from termination of infusion of the anesthetics to recovery of spontaneous breathing, eye opening at command and tracheal extubation were 4.5 ± 1.9,6.4 ± 2.7 and （ 12.6 ± 1.5） min respectively. Conclusion Sufentanil 0.1-0.3 μg·kg^-1·h^-1 combined with propofol 1-4 mμ can inhibit stress response during video-assisted endoscopic transthoracic sympathectomy with stable hemodynamics.