氧化亚氮长时间吸入对肿瘤患者手术后血液学的影响

Hematologic Effect of Prolonged Inhalation Anesthesia with Nitrous Oxide Postoperative in Oral-maxillofacial Tumor

目的探讨50%氧化亚氮(N2O)长时间吸入对七氟醚吸入麻醉下口腔-颌面肿瘤患者手术后血液学的影响。方法选择拟在全麻下行口腔-颌面肿瘤择期手术(手术时间达8 h左右)患者27例,男20例,女7例。ASA I或Ⅱ级。年龄47～65岁。随机分为两组:对照组(Ⅰ组)n=14,N2O组(Ⅱ组)n=13,气管插管后至手术结束期间,Ⅰ组吸入空气氧气混合气体使O2浓度为50%,Ⅱ组吸入50%N2O复合50%O2,两组术中均以七氟醚、瑞芬太尼和罗库溴铵维持麻醉,于麻醉前、手术后第1、3、6、9、11 d,采静脉血测网织红细胞数、血小板数、白细胞数和中性粒细胞数。结果与术前相比,网织红细胞比率术后第3 d开始上升,6～9 d达高峰;白细胞数与中性粒细胞数术后第1 d开始就显著升高,持续至第11 d;两组血小板计数术后先下降,第3 d后缓慢上升。各时间点两组间上述各指标差异,无统计学意义(P>0.05)。结论 50%N2O长时间吸入对七氟醚吸入麻醉下口腔颌面肿瘤患者术后血液学无显著影响。

Objective To investigate the hematologic effect of prolonged inhalation anesthesia with nitrous oxide postoperative in oral-maxillofacial carcinima patients.Methods 27 cases of such patients,ASA I or Ⅱ,aged 47～65 years,male 20 cases and female 7 cases,who would suffered prolonged elective surgery for oral-maxillofacial tumor（Operation time would be about 8 h）,were divided into 2 groups： control group（group I） which inhaled oxygen gas mixture made concentration of O2 to 50% and group Ⅱ which inhalation is 50%N2O.All patients keep anesthesia with sevoflurane,remifentanil,and rocuronium,but were randomly assigned to receive 50% O2 or 50% N2O.Reticulocyte count,Absolute white blood cell count,neutrophils and platelet count in peripheral venous blood were measured before anesthesia and 1,3,6,9,11 days postoperation.Results The reticulocyte count increased at 3 days postoperation and reached the peak until 6～9 days after surgery.White blood cell count and neutrophils increased on the first postoperative day,then decreased gradually.Platelet count initially decreased,then returned to exceed preoperative levels.However there was no significant difference in reticulocyte count,Absolute white blood cell count,neutrophils and platelet count between the two groups.Conclusion During the prolonged inhalation anesthesia,nitrous oxide does not have any effect on the postoperative hematology.