芬太尼-异丙酚-N_2O复合麻醉应用于胸科手术的可行性

Feasibility of propofol-fentanyl-N_2O anesthesia for thoracic surgery

目的 评价芬太尼 -异丙酚 - N2 O复合麻醉在胸科手术的应用。方法 40例 ASA ～ 级胸科择期手术病人随机分为 、 组。 组用硫喷妥钠诱导 ,吸入 (2～ 3) %安氟醚维持麻醉。 组用异丙酚诱导 ,然后用微量泵以 2～ 4mg· - 1 kg· h- 1 的速度持续输入、吸入 (5 0～ 6 0 ) % N2 O并间断静注芬太尼维持麻醉。观察血流动力学并抽取静脉血标本测定血浆 NE、E和 ANP浓度。结果 组病人除切皮时 HR降低外。整个麻醉手术中血流动力学稳定 ,(P>0 .0 5 ) ,血浆 NE、E和 ANP水平均无显著变化 ,苏醒明显快于 组 ,术后 4小时绝大多数病人镇静程度为 2或 3级。而 组病人气管插管及切皮时 MAP显著升高 (P<0 .0 5 ) ,插管时 HR、RPP变化显著 (P<0 .0 1)而且 NE也升高 (P<0 .0 1)。结论 胸科手术应用芬太尼 -异丙酚 - N2 O复合麻醉是一种安全、有效的麻醉方法。

Objective To evaluate the feasibility of propofol fentanyl N 2O anesthesia for thoracic surgery Methods Forty adult patients,ASA grade Ⅰ Ⅱ,scheduled for elective thoracic surgery,were randomly divieded into two groups Anesthesia was induced with intravenous thiopental (group Ⅰ,n=20) or propofol (group Ⅱ n=20) combined with fentanyl and succinylcholine,and was maintained with inhalation of 2% 3% enflurane (group Ⅰ) or intravenou infusion of propofol at 2 4 mg·kg -1 ·h -1 ,inhalation of 50% 60% N 2O and intermittent bolus of fentanyl (group Ⅱ) Hemodynamics was recorded during the whole procedures Intravenous blood samples were taken at various times to determine the plasma concentrations of norepinephrine (NE),epinephrine (E)and atrial natriuretic factor (ANP) Results In group Ⅱ the hemodynamics was kept stable except for HR decerease at incision (P>0 05),the NE,E and ANP levels changed unsignificantly (P>0 05);in group I MAP increased markedly during intubation and incision (P<0 05),and HR,RPP and NE level rose vastly (P<0 01) The analepsia duration was shorten in group Ⅱ as compared with that in group Ⅰ (P<0 05) Conclusion The anesthesia with propofol fentanyl N 2O can be applied safely and effectively to thoracic surgery