广州医科大学学报

目的:探讨瑞芬太尼复合异丙酚全麻在老年甲状腺手术中的应用效果。方法:回顾性分析本院2018年09月-2019年06月60例老年甲状腺手术患者临床资料,依照麻醉方式进行分组,将行瑞芬太尼复合异丙酚全麻患者32例纳入A组,将行芬太尼复合异丙酚全麻患者28例纳入B组,对比两组患者诱导前(T0)、诱导后(T1)、插管前(T2)、甲状腺切除时(T3)、拔管时(T4)、术后24 h(T5)、术后48 h(T6)血液动力学、免疫功能变化以及术后苏醒情况与不良反应发生情况。结果:两组患者T0、T1时刻平均动脉压(MAP)和心率(HR)水平比较(P<0.05);A组患者T2、T3、T4时刻HR、MAP水平低于B组(P<0.05);两组患者T0、T4、T5、T6时刻CD⁸⁺水平比较差异无统计学意义(P<0.05);A组患者T4、T5、T6时刻CD⁴⁺、CD⁴⁺/CD⁸⁺水平高于B组(P<0.05);两组意识恢复时间、自主呼吸恢复时间、清醒时间、拔管时间比较(P<0.05);两组不良反应发生率比较(P<0.05)。结论:瑞芬太尼复合异丙酚全麻有利于维持老年甲状腺手术患者围术期血液动力学的稳定,减轻手术创伤对免疫功能的影响,安全性较高。

Objective:To investigate the use of remifentanil combined with propofol for general anesthesia in thyroid surgery for the elderly.Methods:The clinical data of 60 elderly patients who underwent thyroid surgery between September 2018 and June 2019 in our hospital were analyzed retrospectively. According to the anesthesia method,32 patients who received general anesthesia with remifentanil combined with propofol were included in group A,and 28 with fentanyl combined with propofol were included in group B. Hemodynamics,immune function,postoperative recovery and adverse reactions were compared between the two groups at several time points:prior to induction(T0),post-induction(T1),prior to intubation(T2),at the time of thyroidectomy(T3),extubation(T4),postoperative 24 h(T5),and postoperative 48 h(T6).Results:The mean arterial pressure(MAP)and heart rate(HR)in the two groups were comparable at T0 and T1(P>0.05). The HR and MAP in group A were lower than those in group B at T2,T3 and T4(P<0.05). At T0,T4,T5 and T6,the two groups did not differ significantly in level of CD ⁸⁺cells(P>0.05). The levels of CD⁴⁺,CD⁴⁺/CD⁸⁺ cells were higher in group A than in group B(P<0.05)at T4,T5 and T6(P<0.05). The time to recovery of consciousness,time to recovery of spontaneous breathing,time to awake,time to extubation,and incidence of adverse reactions were different between the two groups(allP> 0. 05).Conclusion:General anesthesia using remifentanil and propofol is beneficial for maintenance of stable hemodynamics during the peri-operative period of thyroid surgery in the elderly,with milder impact of surgical trauma on the immune function,and higher patient safety.