胃部手术患者丙泊酚靶控输注复合舒芬太尼或芬太尼麻醉的效果比较

目的评价胃部手术患者丙泊酚靶控输注复合舒芬太尼或芬太尼麻醉的效果。方法择期胃部手术患者40例,ASAⅠ级或Ⅱ级,随机分为2组,每组20例。丙泊酚加舒芬太尼组（S组）和丙泊酚加芬太尼组（F组）,术中S组持续输注舒芬太尼0.02～0.05μg·kg^-1·min~^-1,F组单次静脉注射芬太尼,每次1～2μg/kg。分别于麻醉诱导前（T0,基础值）、气管插管前即刻（T1）、气管插管后即刻（T2）、切皮后即刻（T3）、胃部手术约50%（T4）、皮下缝合开始后即刻（T5）、拔除气管导管即刻（T6）和拔除气管导管后30 min（T7）各时间点记录平均动脉压（MAP）和心率（HR）。术后恢复阶段观察患者的自主呼吸恢复时间、轻唤睁眼时间、拔管时间,并于拔管后5 min记录患者的警觉/镇静评分（OAA/S评分）。结果 F组在T2、T3、T5时MAP及HR均高于S组（P〈0.05）;F组的自主呼吸恢复时间、轻唤睁眼时间、拔管时间较S组延长（P〈0.05）;F组拔管后5 min OAA/S评分低于S组（P〈0.05）。2组术中、术后并发症发生率比较差异无统计学意义（P〉0.05）。结论在胃部手术时联合应用丙泊酚和舒芬太尼进行全凭静脉麻醉（TIVA）,能提供更为稳定的血流动力学,患者术后苏醒快、苏醒质量高,麻醉可控性更好。

Comparison of the effects between controlled infusion of propofol combined with fentanyl or sufentanil in patient with gastric surgery

Objective To compare the effects between controlled infusion of propofol combined with fentanyl or sufentanil on patients who underwent gastric surgery.Methods Forty adult patients of ASA gradeⅠorⅡwho underwent elective gastric surgery were randomly divided into two groups,sufentanil group（group S,n =20） and fentanyl group（group F, n =20）.Anesthesia was induced with midazolam,propofol and sufentanil or fentanyl.After tracheal intubation,patients in group S received continuous intravenous infusion of sufentanil at a speed of 0.02～0.05μg·kg~（-1）·min~（-1） while patients in group F received a bolus of fentanyl 1～2μg/kg when necessary.Anesthesia was maintained by target-controlled infusion of propofol with initial target concentration of 2μg/ml,dose was increased progressively until satisfied anesthesia was achieved. Sufentanil infusion was stopped after skin closure.The anesthetic efficacies of the two groups were evaluated based on hemodynamic changes（MAP and HR） at seven time points throughout the operation.After operation,time to spontaneous respiration recovery,eye opening and extubation were recorded.The OAA/S score was evaluated at 5 minutes after extubation.Results Patients in group F experienced significantly higher MAP after tracheal intubation and headpins insertion（P〈0.05）.Patients in group S experienced significantly lower HR during operation and skin closure（P〈0.05）.Time to spontaneous respiration recovery,eye opening and extubation was significantly shorter in group S than in group F（P〈0.05）.The OAA/S score was significantly higher in group S（P〈0.05）.No significant difference of incidence of postoperative complications was found between the two groups（P〉0.05）.Conclusion Compared with fentanyl,the use of sufentanil infusion in combination with target controlled infusion of propofol provide more stable hemodynamic changes during gastric surgery.Recovery from anesthesia of propofol sufentanil is faster than that of propofol fentanyl.