地氟醚、七氟醚、异氟醚和安氟醚药代动力学特征的比较研究

The pharmacokinetic study of desflurane, sevoflurane, isoflurane and enflurane in general anesthesia

目的比较地氟醚、七氟醚、异氟醚、安氟醚在平衡麻醉中的药代动力学特征。方法选择妇科手术患者４０例，随机分为地氟醚（Ｄ）组，七氟醚（Ｓ）组，异氟醚（Ｉ）组及安氟醚（Ｅ）组，每组１０例。麻醉诱导、气管插管后，各组均先给予等效的设定浓度，即Ｄ组６％、Ｓ组２％、Ⅰ组１２％、Ｅ组１７％。同时吸入１∶２的Ｏ２和Ｎ２Ｏ，经静脉持续输入芬太尼和间断追加肌肉松弛药泮库溴铵维持麻醉。术中连续监测吸入麻醉药的肺泡浓度及吸入浓度，并维持肺泡浓度衡定在１ｍｏｌ／ＬＡＣ，即Ｄ组３％，Ｓ组０７％，Ⅰ组０５％，Ｅ组０６％。结果吸入麻醉后，肺泡浓度∶吸入浓度＝１／２及肺泡浓度达到１ｍｏｌ／ＬＡＣ值时间在Ｄ组及Ｓ组均明显快于Ⅰ组及Ｅ组。肺泡浓度∶吸入浓度及肺泡浓度∶设定浓度比值的升高速度在Ｄ组和Ｓ组均明显快于Ⅰ组和Ｅ组。终止麻醉后，Ｄ组肺泡浓度达到肺泡原始浓度５０％的时间明显快于其它吸入麻醉药。结论地氟醚吸入及呼出均较快。

Objective To compare pharmacokinetics of desflurane, sevoflurane, isoflurane and enflurane in general anesthesia. Methods 40 patients scheduled for abdominal hysterectomy under general anesthesia were randomly divided into desflurane(D),sevoflurane(S), isofluane(I) and enflurane(E) groups. After induction of anesthesia and endotracheal intubation, desired fraction (Fd) of desflurane(6%), sevoflurane(2%), isoflurane(1.15%) and enflurane(1.7%) in oxygen and nitrous oxide(1:2) were inhaled in D,S,I and E groups, respectively. The fractional end tidal alveolar concentration (Fa) was adjusted to 1MAC during the maintenance of anesthsia. Fa and the fractional inspired concentration of inhaled anesthetics (Fi) were monitored continuously. During operation, fentanyl was infused continuously and pancuronium was injected intermittently. Results After the beginning of inhalational anesthesia, the time required for Fa/Fi=1:2 and Fa=1MAC in D and S groups was significantly shorter than that in E and I groups. The rates of Fa/Fi in D and S groups were significantly higher than those in E and I groups during the maintenance of anesthesia, so were those of Fa/Fd. After cessation of inhalational anesthesia, the time required for Fa equaled to 50% of Fa0(the last Fa during stoping administration of the inhalational anesthesia) in D group was significantly faster than that in the other three groups. Conclusions The rates of desflurane wash in and wash out are faster than those of other inhaled anesthetics. The depth of anesthesia is easy to control when desflurane is used in general anesthesia.