异丙酚复合瑞芬太尼单肺通气麻醉对患者的影响

目的：探讨异丙酚复合瑞芬太尼单肺通气麻醉对开胸手术患者呼吸、循环系统和应激反应的影响。方法：将择期行开胸手术患者60例，ASAⅠ～Ⅱ级，随机分为观察组和对照组，每组各30例。观察组（I组）给予异丙酚复合瑞芬太尼麻醉，麻醉维持给予持续输注瑞芬太尼0．10～0．25μg／（kg·min）和血浆靶控异丙酚1～3μg／m]，间断静脉注射维库溴胺0．02mg／kg；对照组（Ⅱ组）给予静吸复合麻醉，麻醉维持给予持续静脉输注瑞芬太尼0．10～0．25μg／（kg·min）和吸入1％～3％异氟烷，间断静脉注射维库溴胺0．02mg／kg。连续监测患者血压（SBP）、心率（HR）、血氧饱和度（PaO2）、心电图、平均动脉压（MAP）、呼气末二氧化碳分压（PetCO2）和麻醉深度指数。分别在麻醉前基础值（T0）、手术切皮前5min（T1）、切皮后5min（T2）、切皮后（OLV期间）30min（T3）和术毕前10min（T4）采桡动脉血3ml，评价两组患者的血气指标和应激反应程度。结果：L时，Ⅰ组SpO2显著高于Ⅱ组，差异有统计学意义（P〈0．05）；T1、T2、T4时，Ⅰ组PaO2显著高于Ⅱ组，差异有统计学意义（P〈0．01）；T1时，Ⅰ组SBP显著低于Ⅱ组，差异有高度统计学意义（P〈0．01）；T1、T4时，I组HR显著低于Ⅱ组，差异有统计学意义（P〈0．05）；T1时，Ⅰ组DBP显著高于Ⅱ组，T4时，Ⅰ组DBP显著低于Ⅱ组，差异有统计学意义（P〈0．05）；T3、rr4时，I组皮质醇（C0r）显著低于Ⅱ组，差异有统计学意义（P〈0．01，P〈0．05）；T4时，Ⅰ组血管紧张素Ⅱ显著高于Ⅱ组（P〈0．05）；T1、T2、T3、T4时，Ⅰ组IL-6显著低于Ⅱ组（P〈0．01）；各个时刻两组INS比较，差异无统计学意义（P〉0．05）。结论：异丙酚复合瑞芬太尼相对于异氟醚复合瑞芬太尼行单肺通气麻醉，对呼吸系统、循环系统的影响较小，应激反应较少，术中、术后并发症少。

Effect of Propofol combined with Remifentanil in one-lung ventilation anesthesia on patients

Objective： To observe the effects of Propofol combined with Remifentanil anesthesia on the respiration, circulation system and stress reaction of patients during one-lung ventilation （OLV）. Methods： 60 cases of ASA I - II patients for elective thoracic surgery were randomly divided into observation group and control group, each of 30 cases. Total intrave nous anesthesia was given to the observation group （group I ）, which was maintained with Propofol 1-3 μg/ml and continuous Remifentanil 0.10-0.25 μg/（kg·min）, intermittent intravenous injection Vecuronium 0.02 mg/kg. Intravenous-inhalation anesthesia was given to the control group （group II）, which was maintained with 1%-3% Isoflurane inhalation and continuously intravenous Remifentanil 0.10-0.25 μg/（kg·min）, intermittent intravenous injection Vecuronium 0.02 mg/kg. BP, MAP, HR, SpO2, ECG, CSI and PetCOawere continuously monitored. Blood samples were taken from the radial artery before anesthesia （T0）, 5 rain before skin incision （T1）, 5 min after skin incision （Ta）, 30 min after skin incision （OLV, T3） and 10 rain before the end of operation （T4） for measurement of blood gases and stress reaction index. Results： At T3, SpO2 in group I was significantly higher than that of group II （P〈0.05）; at T1, T2, T4, PaO2 in group I was significantly higher than that of group II （P〈0.01）; at T1, SBP in group I was significantly lower than that of group II （P〈0.01）; at T1, T1, HR in group I was significantly lower than that of group II （P〈0.05）; at T1, DBP in group I was significantly higher than that of group II （P〈0.05）; at T4, DBP in group I was significantly lower than that of group II （P〈0.05）; at T3, T4, Cot in group I was signifi cantly lower than that of group II （P〈0.01, P〈0.05）; at T4, Angiotensin II in group I was significantly higher than that of group II （P〈0.05）; at T1, T2, T3, T4, IL-6 in group I was significantly lower than that of group II （P〈0.01）; INS in each time of the two groups, the difference was not statistically significant （P〉0.05）. Conclusion： Compared with Isoflurane, Propofol combined with Remifentanil anesthesia during OLV can stabilize the respiratory and circulatory system, reduce the stress response, and there are few complications during and after operation.