比较地氟烷与异氟烷对胃旁路手术的病态肥胖患者麻醉后苏醒的影响

Comparison of the influence of desflurane inhalation versus isoflurane inhalation on the morbidly obese patients undergoing laparoscopic gastric bypass surgery keeping adequate anesthetic depth and recovery

目的在双频指数（BIS）监测仪监测下，比较病态肥胖患者用地氟烷或异氟烷（静脉麻醉药）麻醉后的苏醒速度和质量。方法40名病态肥胖患者（体质量指数≥35kg·m^-2）随机分为2组，静脉麻醉诱导、气管插管后，以地氟烷或异氟烷维持麻醉，保持BIS在40～50和血流动力学的平稳；缝皮开始，将吸入麻醉剂减少，维持BIS在60，术毕停止吸入麻醉剂。结果全麻药用量及接受其他辅助用药患者的数量2组比较均无明显差异；患者能呼之睁眼、握手、拔管、定向力恢复的时间：地氟烷组[（8．1±3．7），（9．8±4．1），（10．6±4．1），（14．1±5．5）min]明显〈异氟烷组[（13．2±4．9），（15．6±6．3），（16．9±6．9），（21．9±8．2）min]（P〈0．05）；地氟烷组患者达到Aldrete9分的时间也明显〈异氟烷组（P〈0．05）。结论在BIS监测下，地氟烷和异氟烷均能维持适当的麻醉深度和血流动力学的稳定；但地氟烷的苏醒速度较快。

Objective To compare the efficacy and recovery profile of isoflurane and desflurane as the main anesthetics for morbidly obese patients under bispectral index（BIS） monitoring. Methods Forty morbidly obese patients （body mass index ≥35 kg · m^-2） were randomly assigned into two groups. After intravenous induction of general anesthesia and tracheal intubation, anesthesia was maintained with either desflurane or isoflurane as the main anesthetics. The concentrations of the volatile drugs were adjusted to maintain BIS between 40 to 50 and hemodynamic stable. When the surgeon started the skin suture, the end -tidal concentration of the inhalational drug was reduced to keep BIS at 60. At the last skin suture, the inhalational drug was discontinued. During the postope - rative period the Adrete test was carried out to evaluate the intermediate recovery. Results No differences in anesthetic exposure and intraoperative adjuvants consumptions were found between the two groups. Eye opening, hand grip, extubation and orientation times of desflurane [ （8.1±3.7） ,（9.8±4.1） ,（10.6±4.1） ,（14.1±5.5） mini were shorter than isoflurane[ （13.2 ±4.9） ,（15.6±6.3）, （16.9 ±6.9）, （21.9±8.2） min] （P 〈 0.05 ）. The time for Aldrete score reaching 9 wassignificantly shorter after desfurane than isoflurane （ P 〈 0.05 ）. Conclusion Under BIS monitoring, both desflurane and isoflurane can provide a safe and effective intraoperative control of hemodynamic stability and keep adequate anesthetic depth in morbidly obese patients. But desflurane has the advantage of a faster recovery and earlier discharge from the postanesthesia care unit than isoflurane.