七氟烷吸入复合丙泊酚或瑞芬太尼应用于经皮肾镜取石术的研究

Study on the effects of sevoflurane/propofol and sevoflurane/remifentanil anesthesia in the use of percutaneous nephrolithotomy

目的探讨行经皮肾镜取石术患者应用七氟烷吸入复合丙泊酚或瑞芬太尼麻醉的临床疗效。方法 40例ASA1-2级择期行经皮肾镜取石术的患者,经相同方法诱导后,按照麻醉维持方法不同,随机分为七氟烷-丙泊酚组(P组)和七氟烷-瑞芬太尼组(R组),每组20例。在持续吸入0.65MAC七氟烷的基础上,P组复合静脉输注2～6mg·kg-1·h-1丙泊酚,R组复合静脉输注2～6μg·kg-1·h-1瑞芬太尼。手术结束前15min停吸入,手术结束即刻停静脉麻醉药。记录术中不同时点的血压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)和呼气末二氧化碳分压(PETCO2);观察患者呼吸恢复时间、拔管时间、睁眼时间、术毕至出室时间及拔管时OAA/S评分和从术毕至OAA/S评分达5分时间。记录术中术后不良事件的发生率。结果两组于诱导后MAP和HR均有下降,但与诱导前比较差异无统计学意义。转俯卧位后,两组患者MAP下降均较术前显著(P<0.05)。各时点两组间SpO2和PETCO2无明显差异。拔管时的MAP和HR两组间无明显差别。两组间患者的呼吸恢复时间和拔管时间差异无统计学意义。R组患者睁眼时间、术毕至出室时间均小于P组(P<0.05或P<0.01)。R组患者拔管时OAA/S评分高于P组(P<0.05)。R组从术毕至OAA/S评分达5分时间短于P组(P<0.05)。结论七氟烷吸入复合丙泊酚或瑞芬太尼均可取得满意的麻醉效果,但复合瑞芬太尼麻醉苏醒质量较好。

Objective To investigate the clinic efficacy on sevoflurane/propofol and sevoflurane/ remifentanil anesthesia in the use of percutaneous nephrolithotomy. Methods From January 2008 to June 2009,40 cases with kidney stone underwent percutaneous nephrolithotomy. According to different maintained anesthetic method,the patients were randomly divided into sevoflurane/propofol group （group P） and sevoflurane/remifentanil group（group R）. The each group had 20 cases. The group P received 2-6 mg·kg-1. h-1 propofol infusion, while the group R received 2-6μg·kg-1·h-1 remifentanil infusion to maintain anesthesia based both on the 0.65MAC inhalation of sevofluane.The BP, HR, SpO2 and P^CO2 were recorded in different time point during operation. The end of operation to the time of breath recovery, extubation, open eyes and the end of operation discharge operating room time were observed.OAA/S score at extubation and the end of operation to OAA/S the scores were reached to 5 scores. Incidence of side-effect were recorded during operation and after operation. Results BP and HR were declined after induction in both groups,but the difference was no statistical significant. Compared with pre-induction,the BP was declined significantly after turning into supine in the two groups（P〈0.05）. In the each time point, SpO2 and PETCO2 were no significant difference between two groups. BP and HR were no obvious difference between two groups during extubation. In the time of breath recovery and extubation, there was no significant difference between two groups. In the time of open eyes and the time of end of operation to discharge operative room, the group R was less than that group P（P〈0.05 vs P〈0.01）. In the OAA/S score of extubation, the group R was higher than that group P （P〈O.05）. From the end of operation to OAA/S score reaching time of 5 score, the group R was shorter than that group P （P〈0.05）. Conclusions The sevoflurane/propofol and sevoflurane/remifentanil can get a satisfactory anesthetic result, but sevoflurane/remifentanil is better in the awaked quality of anesthesia.