老年肺癌患者行肺叶切除术采用不同浓度舒芬尼、丙泊酚靶控输注麻醉与传统静脉麻醉比较

目的：比较不同浓度舒芬尼和丙泊酚联合靶控输注麻醉（TCI）与传统全凭静脉麻醉（TIVA）对老年患者行开胸肺叶切除时血流动力学、意识和苏醒的影响。方法：60例全身麻醉下行肺叶切除术的病人，随机分为3组（n=20），舒芬尼初始靶浓度为0．2ng／ml TCI（Ⅰ组）、舒芬尼初始靶浓度为0．3ng／ml TCI（Ⅱ组）、舒芬尼＋丙泊酚单次输注、连续输注（Ⅲ组）。在麻醉的不同阶段分别设定不同的舒芬尼靶浓度，同时根据病人意识情况和脑电双频谱指数（BIS）的变化调整丙泊酚靶浓度，记录入室时（基础值base）、气管插管前即刻（T1）、双腔管调整到位时（T2）、气管插管后3min时（T3）、手术切皮时（T4）、手术后15min（T5）和拔管即刻（T6），记录MAP、HR、BIS、丙泊酚、舒芬尼用量及术毕睁眼时间和拔管时间。结果：3组间脑电双频谱指数（BIS）比较差异无统计学意义（P〉0．05）。舒芬尼用量Ⅰ组与Ⅱ组和Ⅲ组比较差异有统计学意义（P〈0．05），Ⅱ组和Ⅲ组比较差异无统计学意义（P〉0．05）。丙泊酚用量Ⅰ组与Ⅱ组和Ⅲ组比较有统计学意义（P〈0．05），Ⅱ组和Ⅲ组比较差异有统计学意义（P〈0．05）。结论：舒芬尼0．2～0．6ng／ml靶控输注既能保证充分的镇痛和足够意识水平深度，有利于术中控制性降压，又不影响中等长度手术患者的术后苏醒和拔管；而单次和持续输注30～40ml／h，亦能达到同样的效果，且舒芬尼和丙泊酚用量明显小于靶控输注组。

Comparison different concentration of sufentanil-propofol target-controlled infusion with traditional total intravenous anesthesia in aged patients undergoing pulmonary lobectomy

Objective： To observe different concentration of sufentanil-propofol target-controlled infusion（TCI） with traditional total intravenous anesthesia （TIVA） in aged patients undergoing pulmonary lobectomy. And compare the influence of hemodynamics, conciousness and recovery time from anesthesia. Methods： Sixty aged patients undergoing pulmonary lobectomy were divided into three groups randomly（n= 20）, low dose sulfetanil TCI group （group Ⅰ）, high dose sulfetanil TCI group （group Ⅱ） and traditional TIVA （group Ⅲ）. The incipient concentration of sufentanil in group Ⅰ and group Ⅱ were 0.2 ng/ml, 0.3 ng/ml respectively. During the course of operation and anesthesia the concentrations in effect compartment of sufentanil and propofol were adjusted according to BIS, MAP and HR. These parameters were recorded when the patients entering the operating room （base）, before intratracheal intubation （T1）, the time of double-lumen endobronchial intubation was located （T2）, after intubation three minutes later（T3）, begin operation （T4）, after 15rain （T5） and extubation （T6）. Results： There were not significance in three groups in BIS （P〉0.05）. The dosage of sufentanil in group Ⅰ was bigger than that in other two groups （P〈0.05）, but there were no statistically significance in group Ⅱ and group Ⅲ （P〉0.05）. The dosage of propofol in group Ⅰ was smaller than that in group Ⅱ, but greater than that in group Ⅲ （P〈0.05）. The MAP was degraded at T4, T5 in group Ⅱ and group Ⅲ. And the HR was decreased at T3, T4 and T4 in group Ⅲ. However changes of the MAP and the HR still in the normal ranges. BIS was maintained at 45-55 during operation. After 5-6 min of the end of operation, patient＇ s eyes can be open. About 2 min later, the endobronchial catheter can be extubated. Conclusion： The results suggest that TCI sufentanil-propofol at 0.2-0.6 ng/ml level by Orchestra workstation, not only ensure sufficient analgesia and adequate de