七氟醚、异氟醚和丙泊酚全麻联合硬膜外麻醉对肝硬化患者肝脏部分切除术的影响

Comparison of Recovery of Sevoflurane,Isoflurane and Propofol TCI Anesthesia Combined with Epidural Block during Partial Hepatectomy in Cirrhotic Patients under the Same BIS Depth of Anestheisa

目的:比较七氟醚、异氟醚和丙泊酚全麻复合硬膜外麻醉在肝脏切除术的安全性以及苏醒质量和耗费情况。方法:选择45例ASAI-II,肝脏右叶部分切除患者,随机分为七氟醚组(S组)、异氟醚组(I组)、异丙酚组(P组)。每组患者均联合硬膜外阻滞。3组分别以七氟醚、异氟醚吸入、丙泊酚靶控输注(TCI)维持麻醉,且维持BIS值在50±5,术毕停止用药。记录术中心率、血压、术后睁眼时间、拔管时间、指令时间、定向力时间、达出苏醒室标准时间,以及术后不良反应,并计算麻醉耗费。结果:七氟醚、丙泊酚苏醒较快;3组麻醉不良反应相似;丙泊酚组麻醉费用最高,异氟醚组耗费最低。结论:七氟醚、丙泊酚复合全麻苏醒较快,异氟醚麻醉维持最经济。

Objective：The aim of this study was to compare the recovery of sevoflurane, isoflurane or propofol TCI anesthesia combined with epidural block on partial hepatectomy under the similar depth of anesthesia as guided by bispectral index （BIS） measurements in cirrhotic patients. We hypothesize that sevoflurane or propofol would yield better recovery than isoflurane. Methods： Forty-five patients with liver cirrhosis scheduled for right liver segmentectomy were assigned into three groups with 15 cases each. The patients in group S, Ⅰ and P were given sevoflurane, isoflurane or propofol for the maintenance of anesthesia combined with epidural block with a similar BIS value of 50± 5. Hemodynamic values, recovery profile and BIS value were recorded as well as adverse events. The consumption of the three anesthetics was also calculated. Results： The quality of recovery in the S group and the P group were better. The hemodynamie was stable during the operation. The three groups had the similar side effects. The cost for maintenance of anesthesia, exincluding wasted drugs, was highest in the P group and lowest in the Ⅰ group. Conclusion：A trend towards a better recovery profile was obtained with propofol and sevoflurane during liver operation in cirrhotic patients. The maintenance of isoflurane sounds economic.