自主呼吸下全凭静脉麻醉在胸腔镜手术围手术期血流动力学变化的观察

Hemodynamics changes in patients underwent video-assisted thoracoscopic surgery with total intravenous anesthesia under spontaneous breathing during perioperative period

目的:观察自主呼吸下全凭静脉麻醉在胸科手术围手术期血流动力学变化。方法:选择行胸腔镜手术患者40例,以右美托咪定、舒芬太尼和丙泊酚静脉诱导,以瑞芬太尼、丙泊酚和右美托咪定进行术中静脉维持。观察记录麻醉前、开胸前、开胸后15 min、30 min、60 min、关胸时以及关胸后15 min、30 min患者的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脉搏氧饱和度(SPO_2)、脑电双频谱指数(BIS)、中心静脉压(CVP)、心输出量(CO)、心指数(CI)、每搏输出量(SV)、每搏指数(SVI)、每搏变异度(SVV)。结果:患者手术过程中各时间点HR、MAP、CO、CI、SV、SVV、SVI等指标无明显差异。SPO_2开胸后15 min、30 min较开胸前比较有所下降(P<0.05),RR麻醉后与麻醉前比较减慢(P<0.05),开胸后60 min与开胸前比较又有所增加(P<0.05),CVP开胸后所有时间点及关胸时、关胸后15 min、30 min较开胸前比较有所增加(P<0.05)。结论:自主呼吸全凭静脉麻醉下胸腔镜手术围手术期患者血流动力学指标在手术和麻醉过程不同时间并无变化。

Objective：To investigate the hemodynamic changes in patients underwent video-assisted thoracoscopic surgery （ VATS） with total intravenous anesthesia under spontaneous breathing during perioperative period.Methods：Forty patients underwent VATS were included in the study. Intravenous anesthesia was induced with Dexmedetomidine, Sufentanil and Propofol, and maintained with Remifentanil, Propofol and Dexmedetomidine. The heart rate （HR）,mean arterial pressure （MAP）,respiratory rate （RR）,SpO2,bispectral index （BIS）,central venous pressure （CVP）,cardiac output （CO）,cardiac index （CI）,stroke volume （SV）, stroke volume index （ SVI） ,stroke volume variation （ SVV） were determined and recorded before the anesthesia, before the thoracotomy,and at 15 min,30 min and 60 min after the thoracotomy;during the sternal closure;and at 15 min and 30 min after the sternal closure,respectively. Results：There were no significant differences in HR, MAP,CO,CI,SV,SVV and SVI at each time point during the operaion. SpO2 was decreased at 15 min and 30 min after the thoracotomy compared with that before the thoracotomy （ P〈0. 05 ） . RR was decreased after the anesthesia compared with that before the anesthesia （ P〈0.05） ,whereas increased at 60 min after the thoracotomy compared with that before the thoracotomy （ P〈0.05） . CVP at each time points after the thoracotomy,during the sternal closure,and at 15 min and 30 min after the sternal closure was increased compared with that before the thoracotomy （P〈0.05）. Conclusion：No changes of hemodynamic parameters are found in patients underwent VATS with total intravenous anesthesia under spontaneous breathing during perioperative period.