摘要
目的探讨电针复合靶控输注(Target Controlled Infusion,TCI)在单肺通气食管癌开胸手术麻醉中的应用价值。方法选取于我院拟行单肺通气食管癌开胸切除手术患者60例作为研究对象。随机将其分为试验组与对照组,对照组30例采取气管插管全麻及TCI靶控输注维持麻醉深度,试验组30例则在对照组方案基础上辅助电针麻醉,记录两组患者手术麻醉时间、药物用量、苏醒时间、并发症;以及术前(T_(Ⅰ))、插管前即刻(T_(Ⅱ))、插管后1 min(T_(Ⅲ))、切皮即刻(T_(Ⅳ))、去骨时(T_(Ⅴ))、拔管即刻(T_(Ⅵ))时平均动脉压(MAP)、平均心率(HR)、BIS值;术前、术后1天、术后3天简易智能精神状态检查量表(MMSE);并于麻醉诱导前(T_(0))、手术开始2 h(T_(1))、术后1天(T_(2))、术后3天(T_(3))时抽取患者外周静脉血检测IL-1β、IL-6、IL-10、TNF-α浓度。结果试验组手术用时、麻醉时间略低于对照组,但差异无统计学意义(P>0.05),试验组异丙酚、舒芬太尼用量以及苏醒时间均明显低于对照组(P<0.05);T_(Ⅱ)时两组平均动脉压(Mean Arterial Pressure,MAP)、心率(Heartrate,HR)较术前明显降低,且试验组MAP明显低于对照组(P<0.05),但两组T_(Ⅱ)时HR比较无显著差异(P>0.05);T_(Ⅲ)、T_(Ⅵ)时对照组MAP、HR明显高于T_(Ⅰ)时,而试验组MAP、HR与T_(Ⅰ)比较无显著差异(P>0.05)。术后1天、3天试验组简易智能精神状态检查量表(Mini-Mental State Examination,MMSE)评分低于对照组,有显著性差异(P<0.05)。T_(1)、T_(2)、T_(3)时试验组白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子(Tumor Necrosis Factor-α,TNF-α)水平明显低于对照组(P<0.05),白介素-10(IL-10)水平明显高于对照组(P<0.05)。结论采用电针复合TCI靶控输注麻醉方案可有效提升单肺通气食管癌开胸手术麻醉效果,能够降低患者术后认知功能障碍发生风险。
Objective To evaluate application and safety of electroacupuncture combined with TCI target controlled infusion in anesthesia for one lung ventilation esophagectomy for esophageal cancer.Methods 60 patients with esophageal cancer undergoing thoracotomy with one lung ventilation in our hospital were selected as the research objects.They were randomly divided into the experimental group and the control group.The control group was given general anesthesia with tracheal intubation and TCI target controlled infusion to maintain the depth of anesthesia.The experimental group was given electroacupuncture anesthesia on the basis of the anesthesia scheme of the control group.Results The operation time and anesthesia time of the experimental group were slightly lower than those of the control group(P>0.05),and the dosage of propofol,sufentanil and recovery time of the experimental group were significantly lower than those of the control group(P<0.05);At T_(Ⅱ),MAP and HR of the two groups were significantly lower than those before operation,and MAP of the experimental group was significantly lower than that of the control group(P<0.05),but there was no significant difference in HR at T_(Ⅱ),between the two groups(P>0.05);MAP and HR of control group were significantly higher than those of T_(Ⅰ)at T_(Ⅲ)and T_(Ⅵ),but there was no significant difference between test group and T_(Ⅰ)(P>0.05).There were significant differences in MMSE scores between the experimental group and the control group on 1d and 3d after operation(P<0.05).At T_(1),T_(2),and T_(3),the levels of IL-1β,IL-6,and TNF-αin the experimental group were significantly lower than those in the control group(P<0.05).The level of IL-10 was significantly higher than that in the control group(P<0.05).Conclusion TCI combined with electroacupuncture anesthesia can effectively improve the anesthesia effect of one lung ventilation for esophageal cancer thoracotomy,and reduce the risk of postoperative cognitive dysfunction.
作者
李茂军
邓秋霞
朱晓东
彭化文
未彬秀
唐大平
王键
Li Maojun;Deng Qiuxia;Zhu Xiaodong;Peng Huawen;Wei Binxiu;Tang Daping;Wang Jian(People's Hospital of Linshui County,Linshui 638500,China)
出处
《世界科学技术-中医药现代化》
CSCD
北大核心
2022年第4期1660-1666,共7页
Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology
基金
广安市科技局科技创新项目(2019SYF11):针刺麻醉对单肺通气开胸手术术后认知功能的影响,负责人:李茂军。
关键词
电针辅助麻醉
TCI
靶控输注
单肺通气食管癌开胸手术
麻醉效果
术后认知功能障碍麻醉安全性
Electroacupuncture assisted anesthesia
TCI target controlled infusion
One lung ventilation for esophageal cancer thoracotomy
Anesthetic effect
Postoperative cognitive dysfunction
Anesthetic safety
