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[地氟烷和七氟烷麻醉对长期肿瘤手术术后恢复的影响]

[Effects of desflurane and sevoflurane anesthesia on postoperative recovery after long-term tumor surgery].

作者信息

Bai Y, Li C S, Lu X H, Zhou Y, Miao C H

机构信息

Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China.

Department of Anesthesiology, Cancer Hospital, Fudan University, Shanghai 200032, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2020 Aug 4;100(29):2278-2282. doi: 10.3760/cma.j.cn112137-20200422-01273.

Abstract

To analyze the effects of desflurane and sevoflurane anesthesia on postoperative recovery after long lasting tumor surgery. One hundred and sixty patients undergoing endoscopic radical esophagectomy and gastrectomy (80 cases of each surgical type) from November 2019 to March 2020 at Henan Cancer Hospital, were randomized into 4 groups(40): group CS (esophageal cancer+sevoflurane anesthesia), group DS (esophageal cancer+desflurane anesthesia),group CW (stomach cancer+sevoflurane anesthesia) and group DW (gastric cancer+desflurane anesthesia). General anesthesia was induced by intravenous agents in all four groups, which were maintained by inhaled anesthetic during the operation. The mean arterial pressure (MAP), heart rate (HR), and surplus pulse O(2) (SpO(2)) immediately before induction (T(1)), the moment of operation begin (T(2)), operation end (T(3)) and extubation (T(4)) were recorded. Also, the duration required for inhalation anesthetic alveolar concentration reaching 0.5 minimum alveolar concentration (MAC) during induction, the alveolar anesthetic concentration at the beginning of the operation, the duration required for XMAC (patients specific alveolar concentration) declining to 0.5 MAC on recovery period, and the duration of alveolar concentration of 0.5 MAC declining to 0.2 MAC were determined. Additionally, the durations of spontaneous breathing recovery, eyes opening, extubation and recovery of consciousness were recorded. Finally, restlessness score (RS) during recovery period was used to evaluate postoperative agitation. Compared with group CS and group CW, no significant differences in MAP, HR, SpO(2) in group DS and group DW at T(1) to T(4) were found (all 0.05). The durations required for inhalation anesthetic alveolar concentration reaching 0.5 MAC were (5.6±1.3), (5.8±2.1), (3.5±1.5) and (3.8±1.0) min in group CS, group CW, group DS and group DW, where the durations in group DS and group DW were significantly shorter than those in group CS and group CW (32.538, 0.05). The durations of alveolar concentration of 0.5 MAC declining to 0.2 MAC were (6.4±2.2), (7.0±1.5), (4.2±2.2) and (4.1±1.5) min in group CS, group CW, group DS and group DW, and the durations in group DS and group DW were significantly shortened as compared with group CS and group CW (42.113, 0.05). Compared with group CS and group CW, group DS and group DW required significantly shorter time for spontaneous breathing recovery, eye opening,extubation, and directional force recovery after operation (all 0.05). Both desflurane and sevoflurane anesthesia can achieve satisfactory anesthesia depth during long lasting tumor surgery. Desflurane can shorten the recovery time and early extubation, and improve the quality of recovery.

摘要

分析地氟烷和七氟烷麻醉对长时间肿瘤手术后患者术后恢复的影响。选取2019年11月至2020年3月在河南省肿瘤医院行内镜根治性食管癌切除术和胃癌根治术的160例患者(每种手术类型80例),随机分为4组(每组40例):CS组(食管癌+七氟烷麻醉)、DS组(食管癌+地氟烷麻醉)、CW组(胃癌+七氟烷麻醉)和DW组(胃癌+地氟烷麻醉)。四组均采用静脉药物诱导全身麻醉,术中吸入麻醉维持。记录诱导前即刻(T1)、手术开始时(T2)、手术结束时(T3)及拔管时(T4)的平均动脉压(MAP)、心率(HR)及脉搏血氧饱和度(SpO₂)。同时,测定诱导期吸入麻醉药肺泡浓度达到0.5倍最低肺泡有效浓度(MAC)所需时间、手术开始时的肺泡麻醉浓度、恢复期XMAC(患者个体化肺泡浓度)降至0.5 MAC所需时间以及肺泡浓度从0.5 MAC降至0.2 MAC的持续时间。此外,记录自主呼吸恢复时间、睁眼时间、拔管时间及意识恢复时间。最后,采用恢复期躁动评分(RS)评估术后躁动情况。与CS组和CW组相比,DS组和DW组在T1至T4时的MAP、HR、SpO₂差异均无统计学意义(均P>0.05)。CS组、CW组、DS组和DW组吸入麻醉药肺泡浓度达到0.5 MAC所需时间分别为(5.6±1.3)、(5.8±2.1)、(3.5±1.5)和(3.8±1.0)min,DS组和DW组所需时间明显短于CS组和CW组(P=32.538,P<0.05)。CS组、CW组、DS组和DW组肺泡浓度从0.5 MAC降至0.2 MAC的持续时间分别为(6.4±2.2)、(7.0±1.5)、(4.2±2.2)和(4.1±1.5)min,DS组和DW组的持续时间明显短于CS组和CW组(P=42.113,P<0.05)。与CS组和CW组相比,DS组和DW组术后自主呼吸恢复、睁眼、拔管及定向力恢复所需时间明显缩短(均P<0.05)。地氟烷和七氟烷麻醉在长时间肿瘤手术中均能达到满意的麻醉深度。地氟烷可缩短恢复时间并实现早期拔管,提高恢复质量。

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