三种全麻维持方法对老年患者血流动力学和苏醒质量影响的比较

目的比较丙泊酚、七氟烷和丙泊酚-七氟烷静吸复合三种麻醉维持方法对老年人血流动力学和苏醒质量的影响。方法 44例ASAⅠ～Ⅱ级胃癌根治术患者随机分入丙泊酚组(P组)、七氟烷组(S组)和静吸复合组(PS组)。术中P组靶控输注丙泊酚,S组七氟烷吸入维持,PS组丙泊酚靶控浓度1μg/mL,复合吸入七氟烷。各组均靶控输注3.5ng/mL瑞芬太尼。调节丙泊酚或七氟烷浓度使AEPI维持15～25,比较三组HR、MAP和术后苏醒质量的差异。结果 S组患者MAP波动幅度小,拔管时间、定向力恢复时间早于另外两组。结论七氟烷吸入麻醉使老年患者血流动力学更平稳,术后苏醒质量更好。

Objective To compare the effects of propofol for total intravenous anesthesia /sevoflurane inhalation and propofol-sevoflurane combined anesthesia on hemodynamics during radical surgery for gastric cancer and state of postoperative recovery in elderly patients.Methods Forty-four ASAⅠ-Ⅱ grade patients with gastric carcinoma undergoing general anesthesia for elective radical surgery,were assigned randomly to three groups,propofol group（group P,14 cases）,sevoflurane group（group S,15 cases） and propofol-Sevoflurane combined group（group PS,15cases）.Anesthesia was induced with propofol and sufentanil in three groups.The scores of AEPI was maintained between 15-25 during operation.Propofol was target controlled infused with intravenous anesthesia in group P.Sevoflurane was inhaled maintaining the state of anesthesia without propofol in group S.In group PS,the target concentration of propofol was maintained at 1μg/mL and the concentration of sevoflurane was inhaled according to the depth of anesthesia.Remifentanil was target controlled infused with target concentration 3.5ng/mL in three groups.The comparison of HR and MAP,the state of awake in postoperation were measured.Results There was significant difference in MAP and awaken time between the three groups（P0.05）,The MAP and hemodynamics was stable undergoing sevoflurane inhalational anesthesia.The intubation and returning normal state of orientation took less time in group S.Conclusion Sevoflurane inhalational and remifentanil combined anesthesia is effective on maintaining hemodynamic stability and state of awakein postoperation.