瑞芬太尼复合异丙酚静脉麻醉应用于肥胖乳腺癌患者根治术的有效性及可控性

Effectiveness and controllability of remifentanil combined with propofol anesthesia for obese patients with breast cancer radical mastectomy

目的探讨瑞芬太尼复合丙泊酚静脉麻醉用于肥胖乳腺癌患者根治术的有效性及可控性。方法选取2010年2月至2015年6月间收治的80例乳腺癌根治术患者,根据体质指数,分为观察组(肥胖者)和对照组(正常体重),均给予瑞芬太尼复合异丙酚静脉复合麻醉,比较两组患者不同时间的血流动力学变化及恢复时间。结果与对照组比较,观察组患者异丙酚用量明显增多,差异有统计学意义(P<0.05)。与入室后比较,对照组患者术后60 min及拔管时平均动脉压(MAP)和心率(HR)均明显降低,差异均有统计学意义(均P<0.05)。与入室后比较,观察组患者诱导后MAP、HR和血氧饱和度(Sp O2)均明显降低,而术后60 min及拔管时,MAP和HR水平均显著降低,差异均有统计学意义(均P<0.05)。与对照组相比,观察组患者睁眼时间、拔管时间,自主呼吸恢复时间均明显延长,差异均有统计学意义(均P<0.05)。结论肥胖乳腺根治术患者瑞芬太尼复合异丙酚静脉麻醉时,血液动力学指标较为平稳,但术后苏醒及恢复较慢。

Objective To explore the effectiveness and controllability of remifentanil combined with propofol anesthesia for obese patients with breast cancer radical mastectomy. Methods According to the body mass index,the 80 patients with breast cancer radical mastectomy received the remifentanil combined with propofol anesthesia in Gong＇an County Chinese Medicine Hospital during the period from February 2010 to June 2015 were randomized into the observation group（ obese） and the control group（ normal bodyweight）. The hemodynamic changes on the different times and recovery time in two groups were compared. Results Compared with the control group,the propofol dosage was significantly increased in the observation group（ P〈 0. 05）; compared with the entering operation-room,the mean artery pressure（ MAP）and heart rate（ HR） were significantly reduced at 60 min after opeation and extubation in the control group（ P〈 0. 05）; compared with the entering operation-room,the MAP,HR,Sp O2 were significantly reduced after induction in the observation group（ P〈 0. 05） and the MAP and HR levels were significantly reduced at 60 min after operation and extubation in the observation group（ P〈 0. 05）; compared with the control group,the time of openning eyes,extubation,recovery of spontaneous breathing were significantly prolonged in the observation gorup（ P 〈0. 05）. Conclusion The hemodynamic index are stable during the remifentanil combined with propofol anesthesia for obese patients with breast cancer radical mastectomy,but the postoperative anlalepsia and recovery are slow.