乳腺癌仿根治术患者丙泊酚复合瑞芬太尼与七氟烷复合氧化亚氮麻醉效果的比较

Anesthetic effects of propofol-remifentanil compared with sevoflurane-nitrous oxide for modified radical mastectomy of breast cancer

目的比较乳腺癌仿根治术患者丙泊酚复合瑞芬太尼麻醉与七氟烷复合氧化亚氮麻醉的效果。方法择期行乳腺癌仿根治术患者60例,ASAⅠ~Ⅱ级,年龄20~60岁,体重45~80 kg。随机分为：丙泊酚复合瑞芬太尼组（PR组）和七氟烷复合氧化亚氮组（SN组）,每组30例。麻醉诱导：PR组丙泊酚剂量2 mg/kg,瑞芬太尼剂量2μg/kg;SN组吸入8%七氟烷-氧化亚氮行肺活量法诱导。麻醉维持：PR组丙泊酚静脉输注速度6~10 mg/（kg.h）,瑞芬太尼静脉输注速度0.2~0.3μg/（kg.min）。SN组维持七氟烷挥发罐刻度为2%~3%。记录两种麻醉诱导的情况;两组患者不同时间点通气和血流动力学及应激水平的改变情况;麻醉时间,睁眼时间,拔除喉罩时间和完全清醒时间;入术后恢复室（PACU）评分情况和用药情况。结果与SN组比较,PR组的睫毛反射消失时间,下颌松弛的时间,诱导时间均缩短,但呼吸暂停的几率明显增多;睁眼时间,喉罩拔除时间,完全清醒时间方面均延长;术后恶心呕吐几率低,但疼痛较明显。结论乳腺癌仿根治术患者,丙泊酚复合瑞芬太尼麻醉或七氟烷复合氧化亚氮麻醉效果均较好,两种麻醉方法相比较无绝对的优势。

Objective To compare the efficacy of anesthesia with target controlled infusion（TCI） of propofol-remifentanil（PR） and sevoflurane-nitrous oxide（SN） for modified radical mastectomy of breast cancer.Methods Sixty patients in ASAⅠ or Ⅱ,aged from 20 to 60 years old,weighing from 45 to 80 kg,scheduled for receiving general anesthesia in elective surgery-modified radical mastectomy of breast cancer were randomly divided into 2 groups（n=30 each）,group PR and group SN.In group PR,anesthesia was induced with propofol and remifentanil.The doses of propofol and remifentanil were 2 mg/kg and 2μg/kg respectively.In group SN the induction of anesthesia was performed by the means of vital capacity with 8% sevoflurane.The target effect-site concentration of propofol and remifentanil were 6~10 mg/（kg·h） and 0.2~0.3 μg/（kg·min） respectively.In group SN anesthesia was maintained with the evaporating concentration of sevoflurane at 2%~3%.The following data were recorded： situations of two inductions,ventilation conditions and the level of homodynamic and stress at different time,including duration of anesthesia,extubation time,situations of entering postanesthesia care unit and drug use.Results Time of eyelash reflex losing and jaw relaxation and the duration of induction were significantly shorter in group PR than in group SN,but incidence of apnea was significantly higher,arousal-eye-opening time,extubation time and clear-headed time were significantly longer.Incidence of nausea/vomiting was lower but severity of soreness was notable after operation.Conclusion Each technique has its advantage and disadvantage for modified radical mastectomy of breast cancer.