摘要
目的 探讨环泊酚对老年患者胸腔镜肺癌根治术中血流动力学和术后苏醒质量的影响.方法 选取2019年7月-2022年7月在南京医科大学附属脑科医院胸科院区行胸腔镜肺癌根治术的108例老年患者,采用随机数字表法将患者分为观察组和对照组,每组54例.观察组给予环泊酚麻醉,对照组给予丙泊酚麻醉,观察两组麻醉诱导前(T0)、诱导后5 min(T1)、拔管即刻(T2)和拔管后5 min(T3,)时心率(HR)、平均动脉压(MAP)、收缩压(SBP)和舒张压(DBP),以及术后苏醒时间、定向力恢复时间、不良反应等,同时分析手术前后应激、炎症因子差异.结果 两组患者T0、T1、T2、T3,的HR、MAP、SBP、DBP比较,结果:①不同时间点的HR、MAP、SBP、DBP比较,差异均有统计学意义(F=4.412、4.603、5.003和4.954,均P＜0.05);②两组患者HR、MAP、SBP、DBP比较,差异均有统计学意义(F=5.154、4.102、4.987和5.884,均P＜0.05);③两组患者HR、MAP、SBP、DBP变化趋势比较,差异均有统计学意义(F=4.412、4.603、5.003和4.954,均P＜0.05).观察组术后苏醒时间、定向力恢复时间短于对照组(P＜0.05).两组患者苏醒期躁动发生率比较,差异无统计学意义(P＞0.05).观察组手术前后去甲肾上腺素、肾上腺素、肿瘤坏死因子-α和白细胞介素-6的差值低于对照组(P＜0.05).观察组呼吸抑制、恶心呕吐发生率低于对照组(P＜0.05).两组患者心动过缓、呛咳、体动发生率比较,差异均无统计学意义(P＞0.05).结论 环泊酚在老年患者胸腔镜肺癌根治术中有较好的麻醉效果,与丙泊酚比较,对血流动力学无明显影响;具有术后苏醒质量好、应激炎症水平低、不良反应少等优点.
Abstract
Objective To investigate the effect of cyclophenol on hemodynamics and postoperative quality of recovery in elderly patients undergoing thoracoscopic radical resection for lung cancer.Methods A total of 108 elderly patients who underwent thoracoscopic radical resection for lung cancer in our hospital from July 2019 to July 2022 were selected,and the patients were divided into the observation group(n=54)and the control group(n=54)by the random number table method.The observation group was given cyclophenol,and the control group was given propofol for anesthesia.The heart rate(HR),mean arterial pressure(MAP),systolic blood pressure(SBP)and diastolic blood pressure(DBP)before anesthesia induction(T0),5 minutes after anesthesia induction(T1),immediately after extubation(T2)and 5 minutes after extubation(T3),as well as the time to postoperative recovery,time to recovery of orientation,and adverse reactions,were observed.Besides,the differences of stress-related factors and inflammatory factors before and after the surgery were analyzed.Results Hemodynamic indexes(HR,MAP,SBP,DBP)at T0,T1,T2 and T3 were compared between the observation group and the control group via repeated measures analysis of variance,and the results revealed that these indexes were different among time points(F=4.412,4.603,5.003 and 4.954,all P＜0.05)and between the observation group and the control group(F=5.154,4.102,4.987 and 5.884,all P＜0.05),and that the change trends of HR,MAP,SBP and DBP were different between the observation group and the control group(F=4.412,4.603,5.003 and 4.954,all P＜0.05).The time to postoperative recovery and time to recovery of orientation in the observation group were shorter than those in the control group(P＜0.05).There was no significant difference between the observation group and the control group in the incidence of agitation during the recovery period(P＞0.05).The differences of levels of norepinephrine,epinephrine,TNF-α and IL-6 before and after the surgery in the observation group were higher than those in the control group(P＜0.05).The incidence of respiratory depression and that of nausea and vomiting in the observation group were lower than those in the control group(P＜0.05).There was no significant difference in the incidence of bradycardia,bucking and body movement between the observation group and the control group(P＞0.05).Conclusions Cyclophenol exhibits a great anesthetic effect in the elderly patients undergoing thoracoscopic radical resection for lung cancer.Compared with propofol,it does not significantly impact on hemodynamics,and has the advantages of better postoperative quality of recovery,lower levels of stress and inflammation,and fewer adverse reactions.
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