地氟烷联合丙泊酚维持麻醉在眼底病日间手术中的应用
Application of desflurane and propofol intravenous maintenance anesthesia on day-case surgery in patients with fundus diseases
曾晶磊 1栗付民 1万营1
作者信息
- 1. 许昌市中心医院麻醉科,许昌 461000
- 折叠
摘要
目的 观察地氟烷吸入麻醉联合丙泊酚静脉注射维持麻醉在眼底病日间手术患者中的应用效果.方法 前瞻性随机对照研究.纳入 2022 年 1 月至 2023 年 8 月许昌市中心医院行日间手术的 90 例眼底病患者作为研究对象.根据随机数字表法将其分为试验组与对照组,每组各 45 例.对照组使用吸入地氟烷进行维持麻醉,试验组在对照组基础上联合使用丙泊酚静脉注射维持麻醉.比较两组患者手术指标、血流动力学指标、疼痛视觉模拟(VAS)评分、炎症因子水平及不良反应.结果 两组患者手术时间、麻醉时间及苏醒时间比较,差异均无统计学意义(均P>0.05).两组患者不同时间的心率(HR)、平均动脉压(MAP)组间比较,差异均无统计学意义(F组间=5.25、5.91,均P>0.05);时间及交互效应比较,差异均有统计学意义(F时间= 6.80、7.32,F交互 = 6.08、6.55,均 P<0.001).试验组静脉给药后 5 min(T1)时点 HR、MAP 高于对照组,差异均有统计学意义(均 P<0.05).试验组手术开始后 15 min(T2)、手术结束时(T3)时点HR、MAP与对照组比较,T1、T2 及T3时点HR、MAP与同组入室5 min后(T0)比较,差异均无统计学意义(均P>0.05);对照组T1 时点HR与同组T0 比较,T1、T2 及T3 时点MAP与同组T0 比较,差异均有统计学意义(均P<0.05).试验组术后各时点VAS评分明显低于对照组,差异均有统计学意义(F组间=4.14,F时间=5.70,F交互=4.82;均P<0.001).两组患者术后C反应蛋白(CRP)、白介素-6(IL-6)水平均高于术前,但试验组术后CRP、IL-6水平[(14.59±2.16)mg/L,(17.59±3.42)pg/mL]明显低于对照组[(16.07±3.85)mg/L,(20.36±4.15)pg/mL],且差异均有统计学意义(t=2.25、3.46,P=0.027、0.001).两组患者头晕、嗜睡及恶心呕吐发生率比较,差异无统计学意义(均P>0.05).结论 吸入地氟烷联合丙泊酚静脉注射维持麻醉用于眼底日间手术可维持术中血流动力学稳定,增强术后镇痛效果,控制炎症反应.
Abstract
Objective To observe the application efficacy of desflurane inhalation anesthesia combined with propofol intravenous maintenance anesthesia on day-case surgery in patients of fundus diseases.Methods This was a prospective randomized controlled study.A total of 90 patients who underwent day-case fundus surgery in Xuchang Central Hospital from Jan.2022 to Aug.2023 were selected as the study subjects.They were divided into the trial group and the control group by random number table method,with 45 patients in each group.The control group was given maintenance anesthesia with desflurane inhalation,while the trial group was given propofol intravenous maintenance anesthesia on the basis of the control group.Surgical indicators,hemodynamic indicators,pain visual analogue scale(VAS)scores,inflammatory factor levels and adverse reactions were compared between the two groups.Results There was no statistically significant difference in surgical time,anesthesia time,or recovery time between the two groups(all P>0.05).There were no statistically significant differences in heart rate(HR)or mean arterial pressure(MAP)between the two groups(Finter-group = 5.25,5.91;all P>0.05).For time effect and interaction effect,there were statistically significant differences(Ftime =6.80,7.32,Finteraction =6.08,6.55;all P<0.001).At 5 min after intravenous administration(T1),HR and MAP of the trial group were higher than those of the control group,and the differences were statistically significant(all P<0.05).There was no statistically significant difference in HR or MAP between the trial group and the control group at 15 min after the beginning of surgery(T2)and at the end of surgery(T3).HR and MAP at T1,T2 and T3 were not significantly different from those of the same group at 5 min after entering the operating room(T0)(all P>0.05).Compared with T0,HR of the control group at T1,MAP of the same group at T1,T2 and T3 showed statistically significant differences(all P<0.05).The VAS scores of the trial group at different time points after surgery were significantly lower than those of the control group(Finter-group = 4.14,Ftime = 5.70,Finteraction =4.82;all P<0.001).The postoperative levels of C-reactive protein(CRP)and interleukin-6(IL-6)in both groups were higher than the preoperative levels.The levels of CRP and IL-6 in the trial group[(14.59±2.16)mg/L and(17.59±3.42)pg/mL]were significantly lower than those in the control group[(16.07±3.85)mg/L and(20.36±4.15)pg/mL](t=2.25,3.46;P=0.027,0.001).The incidence rates of dizziness,drowsiness,nausea and vomiting showed no statistically significant difference between the two groups(all P>0.05).Conclusion Application of desflurane inhalation and propofol intravenous maintenance anesthesia in day-case fundus surgery can maintain intraoperative hemodynamic stability,enhance postoperative analgesic effect and control inflammatory reactions better.
关键词
地氟烷/丙泊酚/维持麻醉/日间眼底手术Key words
Desflurane/Propofol/Anesthesia maintenance/Surgery of day-case fundus disease引用本文复制引用
基金项目
中国红十字基金会医学赋能公益专项基金"医学赋能与人才培养计划"科研项目(79)
出版年
2024
NETL
NSTL
万方数据