瑞芬太尼复合丙泊酚静脉麻醉对食管癌手术患者心血管应激反应的影响

Impact of remifentanil combined with propofol intravenous anesthesia on cardiovascular stress of patients with esophageal cancer surgery

目的探讨瑞芬太尼复合丙泊酚静脉麻醉对食管癌手术患者心血管应激反应的影响。方法选取绵阳市盐亭县肿瘤医院2016年4月—2017年4月收治的食管癌手术患者60例,根据抛硬币法分为A组、B组和C组,各20例。A组患者采用舒芬太尼复合丙泊酚进行麻醉,B组患者采用瑞芬太尼复合丙泊酚进行麻醉,C组患者采用芬太尼复合丙泊酚进行麻醉。比较3组患者麻醉诱导前和麻醉后10、30 min及拔管即刻心率变化情况、拔管时间、呼吸恢复时间、睁眼时间、意识清醒时间、心率、收缩压、舒张压、苏醒期躁动及不良反应发生情况。结果麻醉诱导前,3组患者心率比较,差异无统计学意义(P>0.05);麻醉后10、30 min及拔管即刻,A、C组患者心率比较,差异无统计学意义(P>0.05),B组患者心率低于A、C组(P<0.05)。A、C组患者拔管时间、呼吸恢复时间、睁眼时间及意识清醒时间比较,差异无统计学意义(P>0.05);B组患者拔管时间、呼吸恢复时间、睁眼时间及意识清醒时间短于A、C组(P<0.05)。A、C组患者心率、收缩压、舒张压比较,差异无统计学意义(P>0.05);B组患者心率、收缩压、舒张压低于A、C组(P<0.05)。A、C组患者苏醒期躁动、呼吸抑制、恶心呕吐及剧烈疼痛发生率比较,差异无统计学意义(P>0.05);B患者苏醒躁动期、呼吸抑制、恶心呕吐及剧烈疼痛发生率低于A、C组(P<0.05)。结论瑞芬太尼复合丙泊酚静脉麻醉应用于食管癌手术患者有着较好的麻醉效果,可减轻患者心血管应激反应,具有较高的安全性。

Objective To discuss the impact of remifentanil combined with propofol intravenous anesthesia on cardiovascular stress of patients with esophageal cancer surgery.Methods A total of 60 cases of patients with esophageal cancer surgery were selected from April 2016 to April 2017 in Yanting Cancer Hospital, which were divided into A, B, C group according to coin methods, 20 cases in each group.The A group was given sufentanil combined with propofol anesthesia, B group was given remifentanil combined with propofol anesthesia, C group was given fentanyl combined with propofol anesthesia. The HR before anesthesia induction, after anesthesia of 10, 30 min, immediately after extubation, and extubation time, breathing recovery time, eye opening time, awake time, HR, SBP, DBP, the incidence of agitation and adverse reactions were compared among three groups.Results Before anesthesia induction, no significant differences of HR was found among three groups （ P〉O.05 ） ; after anesthesia of 10, 30 min, immediately after extubation, there was no significant differences of HR between the A and C group （ P〉0.05 ） , the B group of HR was lower than A and C group （ P〈0.05 ） .No significant differences of extubation time, breathing recovery time, eye opening time or awake time was found between the A and C group （ P〉0.05 ） ; the B group of extubation time, breathing recovery time, eye opening time and awake time were shorter than A and C group （ P〈0.05 ） .No significant differences of HR, SBP or DBP was found between the A and C group （ P〉0.05 ） ; the B group of HR, SBP and DBP were lower than A and C group （ P〈0.05 ） .No significant differences of the incidence rate of agitation, respiratory depression, nausea and vomiting or severe pain was found between the A and C group （ P〉0.05 ） ; the B group of he incidence rate of agitation, respiratory depression, nausea and vomiting and severe pain were lower than A and C group （ P〈0.05 ） .Conclusion Remifentanil combined with propofol intravenous anesthesia have a better anesthetic effect in patients with esophageal cancer surgery, it can reduce the cardiovascular stress, and with higher safety.