地氟醚环路内注药法循环紧闭吸入麻醉的应用研究

Desflurane Injection in Closed Circuit Anesthesia

目的：探讨地氟醚环路内注药法用于循环紧闭吸入麻醉的可行性，并观察地氟醚药代动力学的变化。方法：５０例ＡＳＡⅠ～Ⅱ级择期手术全麻病人，咪唑安定、芬太尼麻醉诱导插管行ＩＰＰＶ。氧流量４Ｌ／ｍｉｎ通气５分钟，行最低流量循环紧闭吸入麻醉。根据Ｌｏｗｅ的吸收公式，通过呼气端注入地氟醚的初始剂量，接着用微泵持续输入地氟醚，维持地氟醚的肺泡浓度（ＦＡ）约３％左右，术中根据地氟醚的ＦＡ调整输注速度。切皮前静注芬太尼０１ｍｇ，术中维库溴铵维持肌松，并辅以异丙酚２ｍｇ·ｋｇ－１·ｈ－１。记录地氟醚ＦＡ达３％的时间、呼气末浓度／吸气浓度（ＦＩ）达０８５的时间及其变化趋势。结果：地氟醚用量１０２４±１６３ｍｌ，地氟醚ＦＡ达３％的时间为１１±０４分钟，ＦＡ／ＦＩ达０８５的时间为３１±０１分钟，并能维持于０８５～０９５，恢复呼吸为５７±１３分钟，拔管时间为８３±０９分钟，睁眼时间８６±１６分钟。结论：采用低流量循环紧闭环路内注药法能安全有效地实施麻醉和减少环境污染。

Objective: To study the feasibility of injecting liquid desflurane into closed circuit and the profile of the pharmacokinetics of deflurane.Method:Fifty ASA status patients undergoing surgery were induced with midazolan and fentanyl and ventilated in IPPV with FlO2 4L/min for 5min, which was followed by minimalflow closed circuit anesthesia(CCA). and Ernsts model of anesthetic uptake, the bolus injection of prime dose was needed, then the endexpired concentration of 3% desflurane was maintained by continuous injection of liquid desflurane into the expired limb by means of a syringe pump. The injection rate was adjusted on the base of the endtidal desflurane concentration. Propofol 2mgkg-1h-1 was given.Fentanyl was administered before operation and vecuronium was given by injection. Result:The dose of desflurane was 10216ml. The target concentration was obtained at 1104min.FA/FI at 3101min,and was kept stable during operation. The time of spontaneous breath recovery and extubation was 5713min and Closed circuit 8309min respectively. Conclusion:CCA with desflurane injection is the safe,effective anesthesia with less environmental pollution.