全凭静脉麻醉与静吸复合麻醉恢复质量及用药相关费用的比较

A comparison of recovery profiles and anesthetic-related costs of total intravenous anesthesia vs inhalation-intravenous balanced anesthesia

目的比较相同麻醉深度下异氟醚-芬太尼静吸复合麻醉与丙泊酚复合芬太尼或雷米芬太尼全凭静脉麻醉的恢复质量和用药相关费用。方法ASAⅠ或Ⅱ级,择期行下腹部手术患者60例,随机均分为静吸复合组(B组)、芬太尼组(F组)及雷米芬太尼组(R组),分别以异氟醚-芬太尼、丙泊酚-芬太尼和丙泊酚-雷米芬太尼辅以维库溴铵维持麻醉。麻醉深度维持在NarcotrendD0～D2水平,记录术毕停药后患者自主呼吸恢复时间、呼名睁眼时间、拔管时间、定向力恢复时间;观察拔管后即刻、拔管后20min患者意识状态(OAA/S)、疼痛程度(VAS)及主诉需要镇痛药的例次;术后24h访视患者,记录有无术中知晓及恶心、呕吐等不良反应;比较三种麻醉方式的用药相关费用。结果三种麻醉方式术毕自主呼吸恢复时间、呼名睁眼时间、拔管时间的差异无统计学意义,但R组定向力恢复早于B组,其拔管后20min患者OAA/S评分也高于B组(P<0·01)。R组在拔管后即刻及拔管后20minVAS明显高于其他两组,主诉需要镇痛药者也多于其他两组(P<0·01)。三组患者术后恶心、呕吐等不良反应发生率的差异无统计学意义。B组麻醉用药相关费用明显低于其他两组(P<0·01)。结论三种麻醉方式麻醉苏醒速度相近,丙泊酚-雷米芬太尼苏醒质量较好,但麻醉恢复期疼痛明显。全凭静脉麻醉特别是丙泊酚-雷米芬太尼用药相关费用高于异氟醚-芬太尼静吸复合麻醉。

Objective To compare the recovery characteristics, early postoperative pain and anesthetic-related costs of propofol-fentanyl/remifentanil total intravenous anesthesia（TIVA） with isoflurane/fentanyl balanced anesthesia. Methods Sixty ASA class Ⅰ or Ⅱ patients,aged 27 to 58 years old ,scheduled for selective lower abdominal surgical procedures under general anesthesia were equally randomized into 3 groups. In group B, the anesthesia was maintained with isoflurane and fentanyl,in group R, with remifentanil and propofol, and in group F, with fentanyl and propofol to keep the Narcotrend between D0 and D2. The followings were recorded and compared among the 3 groups： the times of recovering spontaneous breathing, eye opening, extubation, and orientation after termination of anesthesia, OAA/S scores after operation, VAS pain scores, awareness during anesthesia and complications such as nausea and vomiting, anesthetic-related costs of each technique. Results The times of recovering spontaneous breathing, eye opening at request, and tracheal extubation after termination of anesthesia of 3 groups were similar, but the time of orientation recovery was shorter and the OAA/S scores at 20 min after extubation were higher in group R than those in group B （P〈0.01）. VAS after operation was significantly higher in group R than that in group B and F. The incidences of postoperative nausea and vomiting of 3 groups were similar. Drug-related cost was markedly lower in group B than that in group R and F （P〈 0.01）. Conclusion The remifentanil- propofol regimen is associated with better emergence quality and earlier postoperative pain. Anesthetic cost of TIVA,especially the remifentanil-propofol regimen is higher than that of isoflurane balanced anesthesia.