舒芬太尼联合地塞米松对肺癌患者气管拔管时血流动力学的影响

Effects of Sufentanil Combined with Dexamethasone on Hemodynamics of Patients with Lung Cancer when Tracheal Extubation

目的:观察联合应用舒芬太尼和地塞米松对肺癌患者双腔支气管拔管时血流动力学的影响。方法:选择在全麻下行肺癌根治术的患者60例,ASA分级Ⅰ-Ⅱ级,随机分为三组,舒芬太尼组(s组)、舒芬太尼联合地塞米松组(SD组)和生理盐水组(N组),每组20例。SD组于麻醉诱导前静脉推注10 mg地塞米松,手术结束前30 min静脉推注0.15μg/kg舒芬太尼;S组、N组分别于手术结束前30 min静脉推注0.15μg/kg舒芬太尼和2 mL生理盐水;记录麻醉诱导前(T0)、拔管即刻(T1)、拔管后3 min(T2)及拔管后5 min(T3)时的心率(HR),平均动脉压(MAP),并计算心率与收缩压的乘积(RPP);术毕后麻醉恢复时间:自主呼吸恢复时间、睁眼时间、拔管时间。结果:与麻醉诱导前(T0)相比,S组、SD组在手术拔管期各时间点的MAP,HR,RPP变化幅度明显低于N组(P<0.05);SD组较S组血流动力学更加平稳(P<0.05)。S组、SD组虽然自主呼吸恢复时间和睁眼时间与N组比较有所延长,但拔管时间并无显著性差(P>0.05),且S组、SD组比较无统计学差异(P>0.05)。结论:应用舒芬太尼联合地塞米松可以使双腔支气管导管拔管时的血流动力学更加平稳。

Objective： To observe the effects of sufentanil combined with dexamethasone on hemodynamics of patients with lung cancer with a double-Lumen endobronchial tube when tracheal extubation. Methods： 60 patients（ ASA grade Ⅰ - Ⅱ） received lung cancer radical operation with general anesthesia were divided into three groups： sufentail group （group S）, sufentanil combined with dexarnethasone group （group SD） and saline group （ group N）, 20 cases in each group. Before induction of anesthesia, Group SD were given dexamethasone 10 mg; 30 min before the end of operation, Group SD were given0.15 μg/kg sufentanil; S and N group were injected intravenously with 0.15 μg/kg sufentanil and 2 mL saline solution; The HR, MAPR and RPP were recorded before induction of anesthesia（T0）, the moment of extubation（T0, 5min after extubation（T2）, 10 min after extubation （T3）; postoperative anesthesia recovery time： spontaneous breathing time, eye opening time, extubation time. Results： Compared with prior induction of anesthesia （T0）, the values of MAP, HR, RPP in group S, groupSD were lower than that in group N at each time point in the period of thoracic operation extubation （P〈0.05）; GroupSD was more stable than group S on hemodynamics. Although the spontaneous breathing time and eye Opening time were clearly prolonged （P〈0.05） in groupSD and groupS, but extubation time between the three groups has no significant difference （P〉 0.05）. Conclusion： Application of sufentanil combined with dexamethasone in the double-lumen endobronchial tube extubation can make hemodynamics stable.