CAJ | 학술논문

目的：观察右美托咪啶和丙泊酚分别复合瑞芬太尼微泵给药全凭静脉麻醉用于开腹手术患者的效果。方法收集46例择期开腹手术患者（ASAⅠ～Ⅱ级）作为研究对象，按信封法随机分为右美托咪啶组（D组）和丙泊酚组（C组），每组23例。右美托咪啶组（D组）采用右美托咪啶复合瑞芬太尼和维库溴铵麻醉诱导和维持，丙泊酚组（C组）则采用丙泊酚复合瑞芬太尼和维库溴铵麻醉诱导和维持，记录入室后基础值（T0）、麻醉诱导后（T1）、插管后1 min （T2）、切皮后（T3）、腹腔打开时（T4）、腹腔冲洗时（T5）、关腹时（T6）各时点的血流动力学指标；对术中血管活性药物的使用情况进行调查。结果与T0时点比较，右美托咪啶组除T5时点CVP升高明显（ P＜0．0 5）以外，其它时点各项指标表现平稳未见明显变化；而丙泊酚组（C组） T1时点除HR外，其它各项指标均较T0时降低明显（ P＜0．0 5），T2～T4时点各指标有所回升，整体手术过程CO降低明显（ P＜0．0 5），气管插管后1 min SVI降低明显（ P＜0．0 5），与T1时比较，T5时点DBP、CO、SV、SVI等指标回升明显（P＜0．05）；2组患者整体手术过程HR变化差异无显著性（P＜0．05）。两组血管活性药物的使用比较，差异无显著性（P＞0．05），与C组比较，D组在阿托品和硝酸甘油的使用例数上多于C组，而在麻黄碱和去氧肾上腺素使用例数上则少于C组。结论右美托咪啶复合瑞芬太尼全凭静脉麻醉效果确切，与丙泊酚复合瑞芬太尼组比较，更有利于血流动力学参数的平稳，是上腹部手术麻醉较为理想的方法。
목적：관찰우미탁미정화병박분분별복합서분태니미빙급약전빙정맥마취용우개복수술환자적효과。방법수집46례택기개복수술환자（ASAⅠ～Ⅱ급）작위연구대상，안신봉법수궤분위우미탁미정조（D조）화병박분조（C조），매조23례。우미탁미정조（D조）채용우미탁미정복합서분태니화유고추안마취유도화유지，병박분조（C조）칙채용병박분복합서분태니화유고추안마취유도화유지，기록입실후기출치（T0）、마취유도후（T1）、삽관후1 min （T2）、절피후（T3）、복강타개시（T4）、복강충세시（T5）、관복시（T6）각시점적혈류동역학지표；대술중혈관활성약물적사용정황진행조사。결과여T0시점비교，우미탁미정조제T5시점CVP승고명현（ P＜0．0 5）이외，기타시점각항지표표현평은미견명현변화；이병박분조（C조） T1시점제HR외，기타각항지표균교T0시강저명현（ P＜0．0 5），T2～T4시점각지표유소회승，정체수술과정CO강저명현（ P＜0．0 5），기관삽관후1 min SVI강저명현（ P＜0．0 5），여T1시비교，T5시점DBP、CO、SV、SVI등지표회승명현（P＜0．05）；2조환자정체수술과정HR변화차이무현저성（P＜0．05）。량조혈관활성약물적사용비교，차이무현저성（P＞0．05），여C조비교，D조재아탁품화초산감유적사용례수상다우C조，이재마황감화거양신상선소사용례수상칙소우C조。결론우미탁미정복합서분태니전빙정맥마취효과학절，여병박분복합서분태니조비교，경유리우혈류동역학삼수적평은，시상복부수술마취교위이상적방법。
Objective To observe the right supporting the mi organism composite ,fentanyl and propofol respectively micro pumps dosing in patients with intravenous anesthesia used in open operation .Methods 4 6 cases of patients undergoing elective laparotomy (ASAⅠ ~ Ⅱlevel) as the research object ,according to the enve-lope method were randomly divided into the right mi organism group (group D) and propofol group (group C) , 23 cases in each group .Right beautiful mi organism group (group D) using the right mi organism compound , fentanyl and vecuronium bromide ,narcotic induction and maintenance of propofol group (group C) with propo-fol compound ,fentanyl and vecuronium bromide ,narcotic induction and maintenance record after the home base value (T0 ) ,after anesthesia induction (T1 ) ,1 min after intubation (T2 ) ,cut skin after (T3 ) ,abdominal cavi-ty is opened (T4 ) and abdominal cavity flushing (T5 ) ,closed abdomen (T6 ) each time the hemodynamic index-es;To investigate the intraoperative vascular active drug usage .Results Compared with T0 moment ,right beautiful mi organism group except the T5 point CVP increased significantly (P<0 .05 ) ,the other point smooth indicators show no obvious change ;The propofol group (group C) T1 time besides HR ,other all the indexes is T0 reduced significantly ( P<0 .0 5 ) ,the index recovered ,T2 to T4 point integral procedure CO reduced signifi-cantly ( P<0 .0 5 ) ,1 min after endotracheal intubation SVI reduced significantly ( P<0 .0 5 ) ,compared with the T1 ,T5 point DBP ,CO and SV ,SVI index rebounded significantly(P<0 .05 );2 groups of patients with over-all HR operation process changes there was no significant difference ( P<0 .0 5 ) .Two groups of vascular active drug use ,there was no significant difference ( P>0 .0 5 ) ,compared with group C ,group D on the use of at-ropine and nitroglycerin cases than in group C ,while in ephedrine and adrenaline to oxygen use cases is less than group C .Conclusions Right beauty holds the mi organism ,fentanyl by intravenous anesthesia effect is exact , with propofol compound fentanyl group comparison ,more conducive to the smooth hemodynamic parameters ,is more ideal method on abdominal surgery anesthesia .