肺活量法七氟烷诱导与丙泊酚静脉注射诱导在成人腹腔镜手术中麻醉效果的比较

Comparison of Vital Capacity Induction with Sevoflurane to Intravenous Induction with Propofol in Adult Laparoscopic Operation

目的:比较肺活量法高浓度七氟烷吸入诱导与丙泊酚静脉注射诱导在成人腹腔镜手术的麻醉效果。方法选择腹腔镜手术患者44例,ASA分级I~Ⅱ级,年龄22~65岁,性别不限。采用随机数字表法,将患者分成两组(n=22):七氟烷吸入诱导组(S组)和丙泊酚静脉诱导组(P组)。 S组诱导采用肺活量法吸入8%七氟烷结合3L/min氧流量诱导至患者意识消失;P组采用丙泊酚、舒芬太尼和顺苯磺酸阿曲库铵依次诱导至患者意识消失。两组麻醉诱导后均插入喉罩,连接呼吸回路行机械通气;两组术中均采用七氟烷吸入结合静脉靶控输注丙泊酚(靶控血浆浓度3~5μg/ml)维持麻醉。观察指标:麻醉诱导前后即刻、置入喉罩前后即刻、手术开始后(5min、15min、30min)和拔除喉罩时患者的HR、MAP、SpO2和PETCO2变化;观察诱导过程中患者意识消失时间、置入喉罩前后即刻的不良反应、一次置入喉罩成功率和气道压;观察患者术后苏醒时间。结果与P组比较,S组诱导时意识消失时间缩短(<0.05);置入喉罩前后,两组不良反应发生率S组较P组明显减少,且两组不同不良反应发生差异有统计学意义(<0.05);术后苏醒时间比较,S组的自主呼吸和意识恢复较P组缩短(<0.05);两组手术开始后15min、30min时和拔出喉罩即刻的HR比较S组快于P组(<0.05);两组麻醉诱导后、置入喉罩前后即刻以及手术开始5min、15min后即刻患者的MAP比较,P组显著低于S组(<0.05)。结论与丙泊酚静脉麻醉诱导相比,肺活量法七氟烷吸入具有更好的快速麻醉诱导和快速麻醉恢复效果,是腹腔镜手术较理想的麻醉方法之一。

Objective Comparison of vital capacity induction with sevoflurane to intravenous induction with propofol in adult laparoscopic operation.Methods Involved in this study were forty-four adult patients,ASAⅠand II,aged 22-65 yr having elective laparoscopic procedure under general anesthesia.According to a randomization based on computer generated codes the patients were randomized into 2 groups(n=22):group S:8%sevoflurane in O2 3L/min was inhalation via a mask over the patient face whom were encouraged to take addition deep breaths until less of consciousness;and group P:Patient were inducted with 2mg/kg propofol,0.3μg/kg sufentanil and 0.2mg/kg cisatracurium via the peripheral intravenous injuction.The primary outcome was the time to loss of command response,eyelash reflex and muscle tension as wel as inserted successful y.The change of monitoring index including non-invasive blood pressure,heart rate,saturation of pulse oximetry and partial pressure of carbon dioxide in endexpiratory during anesthesia induction as well as time of operative and postoperative anesthetic revival in every patient was also noted.Results Group S had a faster time to achieve loss of command response and muscle tension and inserted successful y as wel as time of postoperative revival(<0.05);the adverse events occurring during the induction and during the at empted insertion of laryngeal mask,cough,hold breath,movement and laryngospasm was more frequent in the group S;and cough,movement,laryngospasm and fluctuation of blood pressure was more frequent in the group P;heart rate increases after anesthesia induction were least in Group P,and greatest in Group S(<0.05);group P developed the blood pressure change occurring immediately after induction,immediately before and after the insertion of laryngeal mask as wel as 5min,15min after operative(<0.05).Conclusion We conclude that a vital capacity induction with high concentration sevoflurane produced a faster loss of consciousness and reduced the incidence of adverse events;and shorten recovery times in adults undergoing laparoscopic operation.