异丙酚复合瑞芬太尼应用于单肺通气麻醉的临床效果观察

Clinical observation of propofol combined with remifentanil in single-lung ventilation anesthesia

目的分析异丙酚复合瑞芬太尼应用于单肺通气麻醉的临床效果。方法选取88例单肺通气麻醉患者作为研究对象,以随机抽签法分为A组(采取异丙酚复合瑞芬太尼麻醉)和B组(采取异丙酚复合芬太尼麻醉),每组44例。比较两组不同时间段[麻醉前(T0)、双肺通气0.5 h(T1)、单肺通气0.5 h(T2)、单肺通气1 h(T3)、再次双肺通气0.5 h(T4)、手术结束(T5)]的各项指标[心率(HR)、平均动脉压(MAP)、动脉血氧分压(PaO_(2))和肺内分流率(Qs/Qt)]及睁眼、自主呼吸和拔管时间。结果A组T1、T3、T4、T5时HR均低于T0时,T5时HR低于B组(P<0.05);B组T3时HR低于T0时,T2时HR高于T1时(P<0.05)。A组T1、T2、T3、T4、T5时MAP均低于T0时,T2、T3、T4、T5时MAP均低于B组(P<0.05);B组T1时MAP均低于T0时,T2、T4、T5时MAP均低于T1时(P<0.05)。A组、B组T1、T2、T3、T4时PaO_(2)高于T0时,T2、T3、T5时PaO_(2)低于T1时(P<0.05)。A组T1、T2、T3、T4时Qs/Qt高于T0时,T2、T3时Qs/Qt高于T1时,T1、T2、T3时Qs/Qt低于B组(P<0.05);B组T1、T2、T3、T4时Qs/Qt高于T0时,T2、T3时Qs/Qt高于T1时(P<0.05)。A组的睁眼时间(6.28±1.60)min、自主呼吸时间(7.29±2.41)min和拔管时间(14.78±5.20)min都明显短于B组的(9.84±1.37)、(16.43±2.08)、(34.42±6.75)min(P<0.05)。结论在单肺通气麻醉中,采取异丙酚复合瑞芬太尼麻醉取得了良好的效果,能够有效改善动脉血氧,降低肺内分流,缩短患者的清醒时间。

Objective To analyze the clinical effect of propofol combined with remifentanil in singlelung ventilation anesthesia.Methods A total of 88 patients with single-lung ventilation anesthesia were selected as research subjects and divided into group A(combined anesthesia with propofol and remifentanil)and group B(combined anesthesia with propofol and remifentanil)by random drawing method,each with 44 cases.Both groups were compared in terms of various indicators[heart rate(HR),mean arterial pressure(MAP),arterial partial pressure of blood oxygen(PaO_(2))and intrapulmonary fshunt fraction(Qs/Qt)]at different time periods[before anesthesia(T0),double-lung ventilation for 0.5 h(T1),single-lung ventilation for 0.5 h(T2),singlelung ventilation for 1 h(T3),double-lung ventilation again for 0.5 h(T4),end of surgery(T5)]and the time of eye opening,spontaneous breathing and extubation.Results HR at T1,T3,T4 and T5 in group A was lower than that at T0,and HR at T5 was lower than that in group B(P<0.05).In group B,HR at T3 was lower than that at T0,and HR at T2 was higher than that at T1(P<0.05).In group A,MAP at T1,T2,T3,T4 and T5 were lower than that at T0,and MAP at T2,T3,T4 and T5 were lower than that in group B(P<0.05).In group B,MAP at T1 were lower than that at T0,and MAP at T2,T4 and T5 were lower than that at T1(P<0.05).In group A and group B,PaO_(2) at T1,T2,T3 and T4 was higher than at T0,and PaO_(2) at T2,T3 and T5 was lower than at T1(P<0.05).In group B,Qs/Qt at T1,T2,T3 and T4 was higher than that T0,Qs/Qt at T2 and T3 was higher than that T1(P<0.05).The time of eye opening,spontaneous breathing and extubation in group A were(6.28±1.60),(7.29±2.41)and(14.78±5.20)min,which significantly shorter than(9.84±1.37),(16.43±2.08)and(34.42±6.75)min in group B(P<0.05).Conclusion In single-lung ventilation anesthesia,propofol combined with remifentanil anesthesia has a good effect,which can effectively improve arterial blood oxygen,reduce pulmonary shunt and shorten patients'waking time.