七氟烷麻醉在老年冠状动脉粥样硬化性心脏病患者胃癌根治术中的应用价值

Application of Sevoflurane anesthesia on elderly coronary heart disease patients received gastric cancer radical operation

摘要:

目的  研究七氟烷预处理在老年冠状动脉粥样硬化性心脏病（以下简称冠心病）患者胃癌根治术中的应用价值。方法  将2012年3月-2014年5月在该院接受胃癌根治术的80例冠心病患者纳入研究对象，采用随机数字表法分为观察组和对照组，进入手术室后，常规监测观察两组患者心电图、脉搏、血氧饱和度等指标，经中心静脉放置肺动脉导管，应用热稀释法检测血液动力学相关指标。①麻醉方法：两组患者均使用咪达唑仑0.31 mg/kg、芬太尼5.1μg/kg和罗库溴铵0.8 mg/kg静脉注射进行诱导后实施气管插管，介入呼吸机实施机械通气，必要时可增加罗库溴铵来保证患者肌松的状态。②术中麻醉维持：对照组泵入异丙酚1.1~2.1 mg/（kg·h），采用瑞芬太尼2.0~3.1μg/（kg·h）进行静脉输注；诱导插管完成后，研究组患者吸入1.5％~2.0％七氟烷，进行七氟烷麻醉，同时采用瑞芬太尼2.0~3.1μg/（kg·h）进行静脉输注，保证两组患者的麻醉深度基本维持在同一水平上。在缝合开始前进行洗脱，保证缝合完成后七氟烷吸入浓度为0。比较两组患者的CK-MB、cTnl、炎性因子含量以及应激反应程度。结果  观察组患者的CK-MB、hs-cTnI、TNF-α、CRP、IL-8、ACTH、Cor、E含量均明显低于对照组（P <0.05）。结论  七氟烷麻醉有助于减少心肌损害，缓解炎症和应激反应，具有更好的心肌保护作用，具有较好的临床应用价值。

Abstract:

Objective To study the application of Sevoflurane anaesthesia on elderly coronary heart disease patients received gastric cancer radical operation. Methods 80 cases patients with elderly coronary heart disease received gastric cancer radical operation in our hospital from 2012 March to 2014 May were enrolled and divided into two groups. Two groups of patients after entering the operating room, regular monitoring observation indices such as ECG, pulse, blood oxygen saturation, the center vein pulmonary artery catheter is placed, applying heat dilution test related parameters of hemodynamics. The anesthesia methods: two groups of patients using Midazolam 0.31 mg/kg, Fentanyl 5.1 μg/kg, and the interaction between Rocuronium 0.8 mg/kg intravenous induction after tracheal intubation, involved in breathing machine implementation of mechanical ventilation, and can increase the interaction between Rocuronium when necessary to ensure that patients with muscle loose state. Maintain: intraoperative anesthesia control pumping Propofol 1.1~2.1 mg/(kg· h), the red Fentanyl mu of 2.0~3.1 g/(kg·h) of intravenous infusion; Team, after the completion of induction of intubation in patients with inhalation Sevoflurane, 1.5 %~2.0 % Sevoflurane pretreatment, at the same time, the red fentanyl mu of 2.0~3.1 g/(kg·h) of intravenous infusion, to ensure that the two groups of patients with anesthesia depth basic maintain at the same level. Before the start of the suture of elution, guarantee the suture after the completion of the concentration of Sevoflurane inhalation of 0. Then CK-MB, cTnl and inflammatory factor levels and stress reaction degree were compared. Results observation group CK-MB, hs-cTnI, TNF-α, CRP, IL-8, ACTH, Cor, E content were significantly lower than that control group. Conclusions Sevoflurane anaesthesia is helpful to reduce myocardial injury, relieve inflammation and stress response, It has better myocardial protection, has good clinical application value.