七氟醚复合麻醉对腹腔镜下老年结直肠癌手术患者动脉血气、脑氧供需平衡的影响

王淑玉　裴晴晴　吴友华　黄巧波

[摘要] 目的 探討七氟醚复合麻醉对腹腔镜下老年结直肠癌手术患者动脉血气、脑氧供需平衡的影响。 方法 选择2019年1—6月在我院接受治疗的老年结直肠癌患者60例，按随机数字表法分为A组和B组各30例，A组采用七氟醚联合芬太尼诱导再联合瑞芬太尼维持麻醉，B组采用丙泊酚联合芬太尼诱导再联合瑞芬太尼维持麻醉。比较两组手术相关指标、住院时间、术中5个时刻[气腹前（T0）、气腹后15 min（T1）、头低脚高（Trendelenburg）体位后15 min（T2）、头低脚高体位后60 min（T3）、停气腹平卧位15 min（T4）]的动脉血pH值、动脉血二氧化碳分压（PaCO2）、颈内静脉血氧饱和度（SjvO2）、动静脉血氧含量差（Da-jvO2）、术后恢复情况及并发症发生率。 结果 两组手术时间、术中出血量、输液量、住院时间比较差异无统计学意义（P>0.05）;两组动脉血的pH值在术中5个时刻比较差异无统计学意义（P>0.05），PaCO2值在T3、T4时刻A组明显低于B组（P<0.05）;A组患者的SjvO2值在T1、T2、T3时刻均明显低于B组（P<0.05）;A组患者的Da-jvO2值在T1、T2、T3时刻均明显高于B组（P<0.05）;A组患者苏醒时间、肠道恢复时间、进食时间、下床活动时间均明显短于B组（P<0.05）;两组患者并发症发生率比较，差异无统计学意义（P>0.05）。 结论 七氟醚复合麻醉有助于腹腔镜下老年结直肠癌手术患者维持稳定的脑氧供需平衡和动脉血气指标，且更有利于患者术后的恢复。

[关键词] 七氟醚;老年结直肠癌手术;动脉血气;脑氧供需平衡

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2021）04-0102-04

Effects of sevoflurane-based anesthesia on the balance of arterial blood gas and cerebral oxygen supply and demand in elderly patients undergoing laparoscopic colorectal cancer surgery

WANG Shuyu   PEI Qingqing   WU Youhua   HUANG Qiaobo

Department of Anesthesiology， Beilun District People's Hospital of Ningbo City， Ningbo 315800， China

[Abstract] Objective To explore the effects of sevoflurane-based anesthesia on the balance of arterial blood gas and cerebral oxygen supply and demand in elderly patients undergoing laparoscopic colorectal cancer surgery. Methods Sixty elderly patients with colorectal cancer who were treated in our hospital from January to June 2019 were selected and divided into group A and group B according to the random number table method. The group A was induced by sevoflurane combined with fentanyl followed by remifentanil to maintain anesthesia. The group B was induced by propofol combined with fentanyl followed by remifentanil to maintain anesthesia. The surgery-related indicators， length of hospital stay， arterial blood pH， arterial blood carbon dioxide partial pressure（PaCO2）， internal jugular vein oxygen saturation（SjvO2）， arterial and venous blood oxygen content difference Da-jvO2， at five time points during the operation （before pneumoperitoneum[T0]， 15-minute after pneumoperitoneum[T1]， 15-minute after post-head low [Trendelenburg] posture[T2]， 60 min after head-low foot high posture[T3]， apnea position for 15 min[T4] after stopping gas abdominal）， postoperative recovery and incidence of complications between the two groups were compared. Results There was no significant difference in the operation time， intraoperative blood loss， infusion volume， and hospital stay between the two groups（P>0.05）. There was no significant difference in the arterial blood pH value between the two groups at five time points during the operation（P>0.05）. The PaCO2 value was significantly lower in group A than that in group B at time T3 and T4（P<0.05）. The SjvO2 value of group A was significantly lower than that in group B at time T1， T2 and T3（P<0.05）. The Da-jvO2 value of the group A was significantly higher than that of group B at T1， T2， and T3（P<0.05）. The recovery time， intestinal recovery time， eating time， and time to get out of bed of patients in group A were significantly shorter than those in group B（P<0.05）. There was no significant difference in the incidence of complications between the two groups（P>0.05）. Conclusion Sevoflurane-based anesthesia can help maintain a stable balance of cerebral oxygen supply and demand and arterial blood gas indexes in elderly patients undergoing laparoscopic colorectal cancer surgery， and it is more conducive to the recovery of patients after surgery.

[Key words] Sevoflurane; Elderly colorectal cancer surgery; Arterial blood gas; Cerebral oxygen supply and demand balance

直肠癌是临床上常见的一类消化道恶性肿瘤，主要由肠组织细胞发生恶性改变而引起，常发生于齿状线至乙状结肠的边界[1]。目前，临床上常采用腹腔镜手术来治疗老年结肠癌，其具有创伤小、出血量少、术后恢复快等多种优势[2]。然而由于老年患者普遍存在生理机能衰退，所以必须考虑到手术可能对老年患者机体产生的影响，包括可能引发的不同程度的应激反应。通常需要……