丙泊酚加瑞芬太尼全凭静脉麻醉对老年胃癌患者应激反应的影响

Influence of Total Intravenous Anesthesia with Propofol and Remifentanil on Stress Response of Elderly Patients with Gastric Cancer

目的分析丙泊酚加瑞芬太尼全凭静脉麻醉对老年胃癌患者应激反应的影响。方法将60例择期胃癌根治术的老年患者随机分为研究组与对照组,各30例。研究组采用全凭静脉输注丙泊酚麻醉,对照组采用吸入异氟烷麻醉。比较两组的心率（heart rate,HR）、血压（blood pressure,BP）、血氧饱和度（oxygen saturation,SpO2）、呼气末二氧化碳分压（end-tidal carbon dioxide partial pressure,PETCO2）、脑电双频指数（bispectral index,BIS）、一氧化氮（nitric ox-ide,NO）等。结果对照组在插管后5min、开皮、探查、拔管时收缩压（systolic blood pressure,SBP）、舒张压（diastolicblood pressure,DBP）、HR的升高较研究组更为明显（P〈0.05）;研究组在插管后5min、开皮时、术终的NO含量增加幅度均较对照组更大（P〈0.05）;对照组拔管后烦躁及嗜睡的发生率明显高于研究组（P〈0.05）。结论丙泊酚全凭静脉输注麻醉可减轻手术患者的应激反应,适合老年胃癌患者的麻醉维持。

Objective To analyze the influence of propofol and remifentanil total intravenous anesthesia on stress response of elderly patients with gastric cancer.Methods Sixty elderly patients with gastric cancer undergoing selective radical gastrectomy were randomly divided into study group and control group（30 cases in each group）.The study group accepted remifentanil total intravenous anesthesia,and the control group accepted isoflurane inhalation anesthesia.Heart rate（HR）,blood pressure,oxygen saturation（SpO2）,end-tidal carbon dioxide partial pressure（PETCO2）,bispectral index（BIS） and nitric oxide（NO） of the two groups were compared.Results The anesthesia time of the study group was（183.2±44.6）min,which was significantly lower than that of the control group（200.8±60.7）min（P〈0.05）.The volume of intraoperative transfusion of the study group was（3100±800）ml,which was significantly lower than that of the control group（3500±1200）ml（P〈0.05）.Five minutes after intubation and during the time of open skin,exploration and extubation,the increase of systolic blood pressure（SBP）,diastolic blood pressure（DBP） and HR of the control group was more significant that that of the study group（P〈0.05）.The increase range of NO content of the study group was larger than that of the control group（P〈0.05）.The incidence of irritability and lethargy after extubation of the control group was significantly higher than that of the study group（P〈0.05）.Conclusion Compared with isoflurane inhalation anesthesia,remifentanil total intravenous anesthesia can decrease the stress response and is more suitable for the anesthesia maintenance of elderly patients with gastric cancer.