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中国现代手术学杂志  2018, Vol. 22 Issue (3): 226-230    DOI: 10.16260/j.cnki.1009-2188.2018.03.016
  临床论著 |
丙泊酚与七氟醚复合麻醉对肝炎肝硬化患者腹部手术后苏醒质量的评价
胡永初1,普隽1,江军1,郑栋煜1,魏祥1,曹宇2
1. 上海长征医院麻醉科，上海 200003; 2.湖南中医药大学附属宁乡医院, 长沙 410600
Evaluation of Intravenousinhalation Compound Anesthesia by Propofol and Sevoflurane on Recovery Quality of Patients with Hepatitis Cirrhosis after Abdominal Surgery
HU Yongchu1, PU Jun1, JIANG Jun1, ZHENG Dongyu1, WEI Xiang1, CAO Yu2
1. Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; 2. Ningxiang Hospital Affiliated to Hunan University of Chinese Medicine, Changsha 410600, Hunan, China
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摘要 目的评估肝炎肝硬化患者腹部手术中应用丙泊酚靶控输注与七氟醚吸入复合麻醉对术后苏醒质量的影响。方法选择我院行腹部手术的86例肝炎肝硬化患者进行前瞻性研究，按随机原则分为两组：研究组43例，行丙泊酚靶控输注与七氟醚吸入复合麻醉；对照组43例，行丙泊酚全凭静脉麻醉。分别于拔管后即刻(T0)、拔管后15 min(T1)、30 min(T2)、60 min(T3)、90 min(T4)五个时间点评估并比较两组患者改良Aldrete评分、改良OAA/S评分及脑电双频指数(BIS)。应用Pearson相关分析苏醒时间与上述指标的相关性。比较两组患者术后自主呼吸恢复时间、拔管时间、苏醒时间及躁动发生率。同时记录并比较两组患者术后呛咳反应及恶心呕吐(PONV)等相关并发症发生率。结果随着拔管时间的延长，两组改良Aldrete评分及改良OAA/S评分均增加，而BIS指数降低，差异均有统计学意义(P<0.05)；同一时间点研究组改良OAA/S评分及改良Aldrete评分高于对照组，而BIS指数低于对照组，差异有统计学意义(P<0.05)。Pearson分析显示苏醒时间与改良Aldrete评分及改良OAA/S评分正相关， 而与BIS负相关(P<0.05)。研究组患者自主呼吸恢复时间、拔管时间、苏醒时间及躁动发生率均显著低于对照组(P<0.05)。两组患者术后并发症发生率比较无统计学差异(P>0.05)。结论肝炎肝硬化患者腹部手术应用丙泊酚联合七氟醚静-吸复合麻醉苏醒较迅速，术后苏醒质量及安全性均较好。
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胡永初1
普隽1
江军1
郑栋煜1
魏祥1
曹宇2
关键词:  丙泊酚  七氟醚  静-吸复合麻醉  苏醒质量  肝硬化，肝炎    
Abstract: Evaluation of Intravenousinhalation Compound Anesthesia by Propofol and Sevoflurane on Recovery Quality of Patients with Hepatitis Cirrhosis after Abdominal SurgeryHU Yongchu1, PU Jun1, JIANG Jun1, ZHENG Dongyu1, WEI Xiang1, CAO Yu2(1. Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; 2. Ningxiang Hospital Affiliated to Hunan University of Chinese Medicine, Changsha 410600, Hunan, China) Abstract:ObjectiveTo evaluate the clinical values of intravenousinhalation compound anesthesia by propofol and sevoflurane on recovery quality of patients with hepatitis cirrhosis after abdominal surgery.MethodsA total of 86 patients with hepatitis cirrhosis performed abdominal surgery were chosen to prospective research and divided into two groups randomly: the research group (43 cases) was carried out the intravenousinhalation compound anesthesia by propofol and sevoflurane, and the control group (43 cases) was performed the total intravenous infusion by propofol anesthesia. The indexes of modified Aldrete score, modified OAA/S score and bispectral index (BIS) were recorded and compared between the two groups at five timepoints, such as extubation immediate time (T0), 15 min (T1), 30 min (T2), 60 min (T3) and 90 min (T4) after extubation. The correlations of recovery time and the above indexes were analyzed by Pearson analysis. The postoperative indexes of recovery time, spontaneous respiration recovery time, extubation time and agitation occurrence were compared between the two groups. The occurrences of complications such as cough response and postoperative nausea and vomiting (PONV) were compared between the two groups.ResultsAs the extubation time went on, the indexes of modified Aldrete score and modified OAA/S score were increasing (P<0.05), but the BIS was decreasing (P<0.05). At the same timepoint, the indexes of modified Aldrete score and modified OAA/S score were higher, but the BIS were lower in the observation group than those in the control group, and the differences were statistical (P<0.05). The Pearson analysis revealed the recovery time was positively correlated with the modified Aldrete score and the modified OAA/S score, but negatively correlated with BIS (P<0.05). Compared to control group, the indexes of spontaneous respiration recovery time, extubation time, recovery time and agitation occurrence in observation group were lower (P<0.05). There was no statistical difference in the incidence of postoperative complications between the two groups (P>0.05).ConclusionThe intravenousinhalation compound anesthesia by propofol and sevoflurane can improve the recovery quality with perfect safety for the patients with hepatitis cirrhosis during the abdominal surgery.
Key words:  propofol    sevoflurane    intravenousinhalation compound anesthesia    recovery quality    liver cirrhosis, hepatitis
               出版日期:  2018-06-26      发布日期:  2018-09-05      期的出版日期:  2018-06-26
ZTFLH:  R614.27  
通讯作者:  普隽，女，34岁，上海长征医院麻醉科主治医师。   
作者简介:  胡永初，37岁，上海长征医院麻醉科主治医师，讲师。
引用本文:    
胡永初1,普隽1,江军1,郑栋煜1,魏祥1,曹宇2. 丙泊酚与七氟醚复合麻醉对肝炎肝硬化患者腹部手术后苏醒质量的评价[J]. 中国现代手术学杂志, 2018, 22(3): 226-230.
HU Yongchu1, PU Jun1, JIANG Jun1, ZHENG Dongyu1, WEI Xiang1, CAO Yu2. Evaluation of Intravenousinhalation Compound Anesthesia by Propofol and Sevoflurane on Recovery Quality of Patients with Hepatitis Cirrhosis after Abdominal Surgery. Chinese Journal of Modern Operative Surgery, 2018, 22(3): 226-230.
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