雷米芬太尼联合依托咪酯靶控输注麻醉用于食管癌手术

Remifentann and etomidate target controlled infusion anesthesia in operation for esophageal cancer

目的探讨雷米芬太尼联合依托咪酯靶控输注麻醉在食管癌手术中的应用，观察其对血流动力学的影响。方法将60例食管癌患者按随机数字表法分为对照组和观察组，每组30例。观察组采用雷米芬太尼联合依托咪酯靶控输注静脉麻醉，对照组采用雷米芬太尼和丙泊酚复合静脉麻醉。观察两组患者平均动脉压（MAP）、心率的变化及术后自主呼吸恢复时间、苏醒时间、拔管时间。结果两组诱导后MAP较人手术室后平卧10rain时均明显降低（P〈0．05），且观察组明显低于对照组（P〈0．05）；两组拔管后5rain时MAP、心率均较入手术室后平卧10min时升高（P〈0．05），且观察组明显高于对照组（P〈0．05）。观察组术后自主呼吸恢复时间、苏醒时间、拔管时间[（513±1．5）、（6．4±2．1）、（8．4±2．5）rain]均明显短于对照组[（16．9±8．7）、（21．3±7．7）、（23．7±5．8）min]（P〈0．05）。结论雷米芬太尼联合依托咪酯靶控输注麻醉用于食管癌手术能够有效维持血药浓度和血流动力学的稳定，并明显缩短患者苏醒时间，提高患者麻醉恢复的质量与安全性。

Objective To investigate the application of remifentanil and etomidate target controlled infusion anesthesia in operation for esophageal cancer and observe its effects on hemodynamics. Methods Sixty patients of esophageal cancer were divided into control group and observation group by random digitstable with 30 cases each. The observation group was given remifentanil and etomidate for induction of the general anesthesia, while the control group was given remifentanil and propofol. The changes of mean arterial pressure （MAP）, heart rate （HR）, postoperative spontaneous breathing recovery time,waking time,extubation time were observed. Results MAP after induction was lower than that lying for 10 minutes after entering operating room in two groups （P 〈 0.05）, and observation group was lower than control group （P 〈 0.05）. MAP, HR after 5 minutes extubation were higher than those lying for 10 minutes after enteringoperating room（P 〈 0.05 ） ,and observation group was higher than control group （P 〈 0.05 ）. The postoperative spontaneous breathing recovery time, waking time, extubation time in observation group [ （5.3±1.5 ）, （6.4±2.1 ）, （8.4±2.5 ） min] were shorter than those in control group [ （ 16.9±8.7 ）, （21.3±7.7）, （23.7±5.8）mini,and there were significant differences （P 〈 0.05）. Conclusion Remifentanil and etomidate target controlled infusion anesthesia in operation for esophageal cancer can maintain the stability of blood concentration and hemodynamics, shorten the recovery time, and improve the quality of anesthesia recoveryand safety.