七氟烷联合瑞芬太尼在胸腔镜肺叶切除手术全身麻醉中的效果

Anesthetic effects of sevoflurane combined with remifentanil on thoracoscopic lobectomy under general anaesthesia

目的 探讨七氟烷与瑞芬太尼联合在胸腔镜肺叶切除手术中的麻醉效果.方法 选取2016年5月至2017年10月医院收治的128例全身麻醉下胸腔镜肺叶切除手术患者,采用随机数表法分为两组,每组64例.对照组采用七氟烷进行麻醉,观察组采用七氟烷联合瑞芬太尼进行麻醉.对比两组患者麻醉诱导前、手术开始时、手术开始30 min及气管拔管时平均动脉压（MAP）及心率（HR）水平,并对比两组患者清醒时间、气管拔管时间、疼痛情况及气管拔管时咳嗽及躁动发生情况.结果 气管拔管时,观察组MAP及HR水平较对照组低,差异有统计学意义（P〈0.05）;观察组清醒时间、气管拔管时间均较对照组短,NRS评分较对照组低,差异有统计学意义（P〈0.05）;观察组咳嗽及躁动发生率较对照组低,差异有统计学意义（P〈0.05）.结论 七氟烷与瑞芬太尼联合在全身麻醉下胸腔镜肺叶切除手术中可有效改善患者气管拔管时的平均动脉压及心率,缩短清醒时间及气管拔管时间,减轻患者疼痛,降低咳嗽及躁动发生率.

Objective To investigate the anesthetic effects of sevoflurane combined with remifentanil on thoracoscopic lobectomy under general anesthesia. Methods From May 2016 to October 2017, 128 patients with thoracoscopic lobectomy under general anesthesia in our hospital were selected, and they were divided into two groups by random number table, with 64 cases in each group. The pa- tients in the control group were given anesthesia with sevoflurane, while the patients in the observation group were given anesthesia with sevoflurane and remifentanil. The mean arterial pressure （MAP） and heart rate （HR） levels before anesthesia induction, at the beginning of operation, at 30 min after the be- ginning of operation, at tracheal extubation time were compared between the two groups. The awakening time, tracheal extubation time, pain, cough and agitation at extubation were compared between the two groups. Results The MAP and HR levels of the observation group were lower than those in the control group at the tracheal extubation time （ P 〈 0.05 ）. The awakening time and tracheal extubation time of the observation group were shorter than those of control group, and the numerical rating scale （NRS） score was lower than that of the control group （ P 〈 0.05 ）. The incidences of cough and agitation in the observation group were lower than those in the control group （ P 〈0. 05 ）. Conclusions Sevoflurane combined with remifentanil in thoracoscopic lobectomy under general anesthesia can effectively improve the MAP and HR levels at the tracheal extubation time, shorten the awakening time and tracheal extuba- tion time, reduce the pain and the incidences of cough and agitation.