中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2010年
7期
579-581
,共3页
麻醉,静脉%麻醉药,联用%导管消融术%输注泵
痳醉,靜脈%痳醉藥,聯用%導管消融術%輸註泵
마취,정맥%마취약,련용%도관소융술%수주빙
Anesthesia,intravenous%Anesthetics,combined%Catheter ablation%Infusion pumps
目的 观察丙泊酚复合雷米芬太尼靶控输注在老年肝癌患者射频消融术中的安全性和有效性.方法 ASAⅡ-Ⅲ级的老年原发性肝癌患者30例,随机分为丙泊酚复合雷米芬太尼靶控输注组(PR组)15例和眯达唑仑复合芬太尼静脉注射组(MF组)15例,择期在有监测的麻醉处理(monitored anesthesia care,MAC)下行肝癌射频消融术.观察治疗中两组患者平均动脉压(MAP)、心率、脉搏血氧饱和度(SpO2)的变化;记录治疗中Ramsay镇静评分、患者合作评分、疼痛VAS评分,以及术后患者满意度.结果 治疗中Ramsay镇静评分、患者合作评分、疼痛VAS评分,以及术后患者满意度,PR组均优于MF组(P<0.05).MF组MAP、心率最高值[(108.7±8.6)mm Hg、(83.8±7.1)次/min]较基础值[(99.3±8.5)mm Hg、(76.3±7.1)次/min]明显增加,增加幅度显著高于PR组(P<0.05);PR组MAP、心率最低值[(84.5±6.5)mm Hg、(66.6±6.6)次/min]显著低于基础值[(97.7±6.5)mm Hg、(75.4±7.3)次/min],降低幅度高于MF组(P<0.05).两组均出现SpO2明显降低(最低值PR组95.1±2.0,MF组95.5±2.2),但两组之间差异无统计学意义(P>0.05).结论 丙泊酚复合雷米芬太尼靶控输注法更适用于老年肝癌患者射频消融术.它能保证良好的镇痛、镇静作用,但术中应注意观察患者的呼吸与血流动力学变化.
目的 觀察丙泊酚複閤雷米芬太尼靶控輸註在老年肝癌患者射頻消融術中的安全性和有效性.方法 ASAⅡ-Ⅲ級的老年原髮性肝癌患者30例,隨機分為丙泊酚複閤雷米芬太尼靶控輸註組(PR組)15例和瞇達唑崙複閤芬太尼靜脈註射組(MF組)15例,擇期在有鑑測的痳醉處理(monitored anesthesia care,MAC)下行肝癌射頻消融術.觀察治療中兩組患者平均動脈壓(MAP)、心率、脈搏血氧飽和度(SpO2)的變化;記錄治療中Ramsay鎮靜評分、患者閤作評分、疼痛VAS評分,以及術後患者滿意度.結果 治療中Ramsay鎮靜評分、患者閤作評分、疼痛VAS評分,以及術後患者滿意度,PR組均優于MF組(P<0.05).MF組MAP、心率最高值[(108.7±8.6)mm Hg、(83.8±7.1)次/min]較基礎值[(99.3±8.5)mm Hg、(76.3±7.1)次/min]明顯增加,增加幅度顯著高于PR組(P<0.05);PR組MAP、心率最低值[(84.5±6.5)mm Hg、(66.6±6.6)次/min]顯著低于基礎值[(97.7±6.5)mm Hg、(75.4±7.3)次/min],降低幅度高于MF組(P<0.05).兩組均齣現SpO2明顯降低(最低值PR組95.1±2.0,MF組95.5±2.2),但兩組之間差異無統計學意義(P>0.05).結論 丙泊酚複閤雷米芬太尼靶控輸註法更適用于老年肝癌患者射頻消融術.它能保證良好的鎮痛、鎮靜作用,但術中應註意觀察患者的呼吸與血流動力學變化.
목적 관찰병박분복합뢰미분태니파공수주재노년간암환자사빈소융술중적안전성화유효성.방법 ASAⅡ-Ⅲ급적노년원발성간암환자30례,수궤분위병박분복합뢰미분태니파공수주조(PR조)15례화미체서륜복합분태니정맥주사조(MF조)15례,택기재유감측적마취처리(monitored anesthesia care,MAC)하행간암사빈소융술.관찰치료중량조환자평균동맥압(MAP)、심솔、맥박혈양포화도(SpO2)적변화;기록치료중Ramsay진정평분、환자합작평분、동통VAS평분,이급술후환자만의도.결과 치료중Ramsay진정평분、환자합작평분、동통VAS평분,이급술후환자만의도,PR조균우우MF조(P<0.05).MF조MAP、심솔최고치[(108.7±8.6)mm Hg、(83.8±7.1)차/min]교기출치[(99.3±8.5)mm Hg、(76.3±7.1)차/min]명현증가,증가폭도현저고우PR조(P<0.05);PR조MAP、심솔최저치[(84.5±6.5)mm Hg、(66.6±6.6)차/min]현저저우기출치[(97.7±6.5)mm Hg、(75.4±7.3)차/min],강저폭도고우MF조(P<0.05).량조균출현SpO2명현강저(최저치PR조95.1±2.0,MF조95.5±2.2),단량조지간차이무통계학의의(P>0.05).결론 병박분복합뢰미분태니파공수주법경괄용우노년간암환자사빈소융술.타능보증량호적진통、진정작용,단술중응주의관찰환자적호흡여혈류동역학변화.
Objective To assess the efficacy and safety of target-controlled infusion of propofol and remifentanil in geriatric patients with hepatocellular carcinoma undergoing percutaneous radiofrequency ablation. Methods Thirty geriatric patients with primary hepatocellular carcinoma of ASA Ⅱ-Ⅲ scheduled for percutaneous radiofrequency ablation under monitored anesthesia care (MAC) were randomly allocated to two groups: target-controlled infusion of propofol and remifentanil group (PR group, n= 15) and intravenous injection of midazolam and fentanyl group (MF group. n= 15). The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) of patients were recorded during the treatment. The Ramsay Score, Patient Cooperation Score, VAS Score and postoperative Patient Satisfaction Score were recorded as well. Results The Ramsay Score, Patient Cooperation Score, VAS Score and Patient Satisfaction Score were all higher in PR group than in MF group (all P<0.05). The maximum values of MAP and HR [( 108.7± 8.6) mm Hg, (83.8±7.1) times/min] were significantly higher than the baseline values [( 99.3 ± 8.5) mm Hg, (76.3±7.1) times/min] in MF group, and the degree of increment of MAP and HR were significantly greater in MF group than in PR group (both P<0.05). The minimum values of MAP and HR [(84.5±6.5) mm Hg, (66.6 ± 6.6) times/min] were significantly lower than the baseline values [(97.7±6.5) mm Hg, (75.4±7.3) times/min] in PR group, and the degree of decrement of MAP and HR were significantly greater in PR group than in MF group (both P<0.05). SpO2 of both groups decreased significantly (the minimum values of PR and MF groups were 95.1±2.0 and 95.5± 2.2, respectively), but there was no statistical difference between two groups (P>0.05) . Conclusions MAC with target-controlled infusion of propofol and remifentanil is more suitable for geriatric patients with hepatocellular carcinoma undergoing percutaneous radiofrequency ablation, as it can provide ideal analgesia and sedation, but the respiration and the change of hemodynamics of patients must be observed seriously.
