七氟醚与瑞芬太尼联用对困难气道患者应激反应、肺功能及血气指标的影响

Effects of sevoflurane combined with remifentanil on stress response,pulmonary function and blood gas in patients with difficult airway

目的探讨七氟醚与瑞芬太尼联用对困难气道患者应激反应、肺功能及血气分析的影响。方法选择2014年6月至2016年7月该院收治的麻醉预计困难气道患者90例,随机分为试验组和对照组,每组45例。试验组使用七氟醚联合瑞芬太尼,对照组使用丙泊酚联合瑞芬太尼进行麻醉。比较两组T0、T1、T2时间点应激反应指标[包括血糖(GLU)、皮质醇(CRO)、去甲肾上腺素(NE)、肾上腺素(NA)、心率(HR)、平均动脉压(MAP)及血氧饱和度(SpO_2)]、肺功能指标[包括QS/QT、肺动态顺应性、P_(peak)、P_(ET)CO_2]、血气指标[包括PaCO_2、PaO_2、pH值]的波动情况。结果两组患者在T0、T1、T2时间点各个指标均存在不同程度的波动。T0时间点两组的GLU、CRO、NA、HR、MAP、SpO_2、NE、QS/QT、肺动态顺应性、P_(peak)、P_(ET)CO_2、PaCO_2、PaO_2、pH值均无明显波动,差异无统计学意义(P>0.05)。T1时间点试验组的PaO_2波动优于对照组,两组比较差异有统计学意义(P<0.05)。T2时间点试验组的SpO_2波动优于对照组,两组比较差异有统计学意义(P<0.05)。T1、T2时间点试验组GLU、CRO、NA、HR、MAP、NE、肺动态顺应性、P_(peak)波动均优于对照组,两组比较差异有统计学意义(P<0.05)。结论七氟醚与瑞芬太尼联用可明显改善困难气道患者应激反应、肺功能,对患者血气分析影响较轻,值得推广。

Objective To investigate the effects of sevoflurane combined with remifentanil on stress response,pulmonary function and blood gas analysis in patients with difficult airway.Methods From June 2014 to July 2016,90 cases of airway patients with anesthesia were randomly divided into test group and control group and of 45 cases each group.The test group used sevoflurane combined with remifentanil,and the control group was treated with propofol combined with remifentanil for anesthesia.Comparison of the two groups before and after anesthesia,intubation after stress response[including blood glucose(GLU),cortisol(CRO),adrenaline(NE),adrenaline(NA),heart rate(HR),mean arterial pressure(MAP)and oxygen saturation(SpO 2)],pulmonary function(including QS/QT,pulmonary dynamic compliance,P peak,P ET CO 2),and blood gas index(including PaCO 2,PaO 2,pH value).Results There are different degrees of fluctuations in the indicators in the two groups at the time of T0,T1,T2.There were no significant differences in GLU,CRO,NA,HR,MAP,SpO 2,NE,QS/QT,pulmonary dynamic compliance,P peak,P ET CO 2,PaCO 2,PaO 2 and pH values in the two groups at the time of T0(P<0.05),the difference was not statistically significant(P>0.05).The PaO 2 fluctuation in the experimental group was superior to that in the control group at the time of T1,the difference was statistically significant(P<0.05).The SpO 2 fluctuation of the experimental group was better than that of the control group at the time of T2,the difference was statistically significant(P<0.05).GLU,CRO,NA,HR,MAP,NE,pulmonary dynamic compliance and P peak fluctuation of the experimental group were better than those of the control group at the time of T1,T2,the difference was statistically significant(P<0.05).Conclusion Combination of sevoflurane and remifentanil can significantly improve the stress response in patients with difficult airway,lung function and the impact of blood gas analysis of patients,it is worth promoting.