瑞芬太尼复合丙泊酚靶控输注麻醉用于肝部分切除术患者临床效果研究*

目的 探讨瑞苏太尼复合丙泊酚靶控输注(TCI)麻醉用于肝脏部分切除术(PHX)患者的麻醉效果。方法 2017年4月～2019年1月我院行PHX的原发性肝癌(PLC)患者86例,随机将患者分为研究组43例和对照组43例,给予对照组患者常规麻醉,给予研究组瑞芬太尼复合丙泊酚TCI麻醉,评价苏醒室标准(Aldrete)和改良警觉-镇静量表(OAA/S)评分。结果 研究组患者拔管时间为(12.7±3.3)min,呼之睁眼时间为(10.1±3.2)min,自主呼吸恢复时间为(9.4±2.1)min,均显著短于对照组【分别为(18.4±5.2)min、(17.6±3.4)min和(16.4±5.4)min,P<0.05】;在T0时,两组应激反应指标比较无显著性差异(P>0.05),但术中研究组应激反应指标水平整体优于对照组(P<0.05);拔管后即刻和拔管后15min,研究组患者Aldrete评分分别为(9.4±0.7)分和(9.4±0.8)分,OAA/S评分分别为(4.3±0.4)分和(4.7±0.4)分,显著高于对照组【分别为(8.3±0.4)分和(8.9±0.5)分,和(3.4±0.4)分和(4.2±0.5)分,P<0.05】;研究组不良反应发生率为11.6%,显著低于对照组的27.9%(P<0.05)。结论 应用瑞苏太尼复合丙泊酚TCI麻醉应用于PHX手术可有效减轻术中应激反应,提高术后苏醒效果,且具有较高的安全性,值得临床验证。

Clinical observation of remifentanil combined with propofol target-controlled infusion anesthesia in patients with primary liver cancer underwent partial hepatectomy

Objective The aim of this study was to investigate the anesthetic efficacy of target-controlled infusion of(TCI)in accordance with propofol in partial hepatectomy.Methods Eighty-six patients with primary liver cancer(PLC)undergoing partial hepatectomy in our hospital between April 2017 and January 2019 were randomly divided into study group and control group with 43 in each.The patients in the control group were given routine anesthesia and those in the study group were anesthetized with remifentanil combined with propofol at the manner of TCI.The extubation time,eye opening time,spontaneous respiratory recovery time,stress response index and standard for coming out of the awakening room(Aldrete)were compared between the two groups.Modified vigilance sedation scale(OAA/S)score was obtained and the complications between the two groups were compared.Results The extubation time,the eye opening time and spontaneous respiratory recovery time in patients in the study group were significantly shorter than those in the control group[(12.7±3.3)min,(10.1±3.2)min and(9.4±2.1)min,vs.(18.4±5.2)min,(17.6±3.4)min and(16.4±5.4)min,respectively,P<0.05];there was no significant difference in stress response index between the two groups at T0(P>0.05),while the level of stress response index in the study group was better than that in the control group(P<0.05)during the operation;immediately after extubation and 15 minutes after extubation,the Aldrete scores in the study group were(9.4±0.7)and(9.4±0.8),and the OAA/S scores were(4.3±0.4)and(4.7±0.4),significantly higher than[(8.3±0.4)and(8.9±0.5),and(3.4±0.4)and(4.2±0.5),respectively,P<0.05] in the control;the incidence of adverse reactions in the study group was 11.6%,significantly lower than 27.9%in the control(P<0.05).Conclusion The application of the compound propofol TCI anesthesia is appropriately applied to the partial hepatectomy,and the stress reaction during the operation could be effectively reduced,which might improve the recovery of patients with PLC after operation.