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七氟烷或丙泊酚复合瑞芬太尼麻醉在重症肌无力患者胸腺切除术中的应用
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七氟烷或丙泊酚复合瑞芬太尼麻醉在重症肌无力患者胸腺切除术中的应用
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Journal Article
七氟烷或丙泊酚复合瑞芬太尼麻醉在重症肌无力患者胸腺切除术中的应用
2013
Overview
目的探讨七氟烷或丙泊酚复合瑞芬太尼麻醉在重症肌无力患者经胸骨正中切口胸腺扩大切除术中的应用,并比较其效果。方法搜集2008年7月-2011年6月于解放军309医院麻醉科行胸骨正中切口胸腺扩大切除术的重症肌无力患者156例,分为2组,其中应用靶控静脉输注丙泊酚和瑞芬太尼麻醉（P组）80例,应用吸入七氟烷复合静脉输注瑞芬太尼麻醉患者（S组）76例,均不加用肌松药。采用4个成串刺激（TOF）检测神经肌肉传递功能。以手术开始（切皮）前作为0时点,每30min记录1次各规定时间点的血流动力学变化,以及基础状态下与拔管后的血气分析及呼吸频率等指标,直至麻醉结束,同时记录麻醉时间、手术时间、清醒时间、麻醉恢复室（PACU）停留时间、拔管时间、输入液体及瑞芬太尼总量。结果两组患者在不使用肌松药的情况下均顺利完成手术,S组手术开始后各时间点TOF值均明显低于P组（P〈0.05）。手术后,P组pH值和PaCO2较S组显著升高（P〈0.05）,PaO2则显著降低（P〈0.05）。在患者清醒时间、拔管时间、PACU停留时间及瑞芬太尼用量的比较上,S组明显低于P组（P〈0.05）。两组患者在血流动力学及脑电双频指数（BIS）、手术时间、麻醉时间、输入液体总量上差异无统计学意义（P〉0.05）。结论重症肌无力患者接受胸骨正中切口胸腺扩大切除术时,在不使用肌松药的情况下,应用七氟烷或丙泊酚复合瑞芬太尼麻醉安全有效。七氟烷复合瑞芬太尼对神经肌肉传递功能的抑制更具有优势,对术后呼吸功能的影响更小。
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