曲马多与芬太尼分别联合丙泊酚用于经皮微波消融治疗肝癌的麻醉效果比较

Anesthetic Effect of Propofol Combined with Tramadol or Fentanyl in Ultrasonically Guided Percutaneous Microwave Coagulation Therapy for Hepatocellular Carcinoma

目的:比较曲马多与芬太尼分别联合丙泊酚用于超声引导下经皮微波消融疗法(percutaneous microwave coagulationtherapy,PMCT)治疗肝癌的麻醉效果。方法:选取择期行PMCT的肝癌患者50例,ASA分级Ⅰ～Ⅱ级,年龄41～67岁,将其随机均分为两组。两组患者均采用靶控输注(target-controlled infusion,TCI)丙泊酚镇静,并以脑电双频指数(BIS)值50±10调节TCI效应室浓度。曲马多组(T组):TCI丙泊酚前缓慢静脉推注1mg/kg曲马多;芬太尼组(F组):TCI丙泊酚前缓慢静脉推注1μg/kg芬太尼。记录两组患者在麻醉诱导前、诱导后和经皮穿刺后3、5、10min的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2)以及其治疗时间、苏醒时间和并发症发生情况。结果:两组患者的治疗时间、苏醒时间和呕吐发生率差异无统计学意义(P>0.05)。F组HR在诱导后和穿刺后3min时显著低于T组(P<0.05);F组SpO2在穿刺后3min和穿刺后5min显著低于T组(P<0.05);F组MAP在诱导后和穿刺后3min显著低于T组(P<0.05);F组心动过缓、低血压及低氧血症的发生率高于T组,差异均有统计学意义(P<0.05)。结论:曲马多与芬太尼分别联合丙泊酚输注用于PMCT治疗肝癌手术,均能达到满意的麻醉效果,但曲马多对患者的呼吸循环影响更小。

Objective：To compare the anesthetic effect of propofol combined with tramadol or fentanyl in ultrasonically guided percutaneous microwave coagulation therapy（PMCT）for hepatocellular carcinoma（HCC）.Methods：Fifty patients with HCC（ASAⅠ-Ⅱ）aged 41-67 years,undergoing ultrasonically guided PMCT were allocated randomly to two groups with 25 patients in each group.Anesthesia was administered with propofol given by target-controlled infusion（TCI）for both groups,and bispectral index（BIS）value was maintained at 50±10 by adjustment of effect-site concentration of propofol.The patients received slowly intravenous 1 mg/kg tramadol（Group T） or 1 μg/kg fentanyl（Group F）before propofol infusion.Heart rate（HR）,mean arterial pressure（MAP） and oxygen saturation（SpO2）were recorded at baseline,induction,after puncture 3 min,5 min and 10 min.PMCT duration,recovery time and adverse effects were also recorded.Results： There were no statistically significant differences between the two groups in vomiting incidence,therapeutic time and recovery time（P0.05）.HR in Group F decreased more than that in Group T after induction and after puncture 3 min（P0.05）.SpO2 in Group F decreased more than that in Group T after puncture 3 min and 5 min（P0.05）.MAP in Group F decreased more than that in Group T after induction and after puncture 3 min（P0.05）.The incidences of bradycardia,hypotension and hypoxemia in Group F were higher than those in Group T（P0.05）.Conclusions： Propofol combined with tramadol or fentanyl can provide satisfactory anesthesia for the operation of HCC with ultrasonically guided PMCT,but tramadol maintains better hemodynamic and respiratory stability.