低流量麻醉在成本管理中的应用

Application of Low-flow Anesthesia in Cost Management

目的探讨低流量麻醉在麻醉科降低成本的作用。方法选择ASAⅠ级或Ⅱ级择期外科手术全麻病人。所有患者采用静脉用1%丙泊酚+0.005%瑞芬太尼根据病人情况调节,异氟醚控制为1.2MAC;用安美西钙石灰为CO2吸收剂。实验组:氧流量350～400ml/min。在气体监测仪FiCO230min内持续升高到8.5mmHg时作为更换钙石灰指标。对照组:用高流量麻醉,流量为2L/min,以使用钙石灰第一次70～90%出现变色时更换。记录患者每小时所需异氟醚毫升数,及PETCO2需要更换钙石灰的时间。结果钙石灰全麻使用时间实验组(853.3±204.8分钟)和对照组(498.9±263.4分钟),差异有显著性。每小时使用异氟醚情况,实验组(7.97±2.56ml/h)远小于对照组(23.91±3.04ml/h)。结论低流量麻醉在麻醉科应用可大大节约吸入麻醉药,降低患者药品支出,而以在30分钟内FiCO2持续升高到8.5mmHg以上作为更换钙石灰指标,不会造成ETCO2、HR、MAP的变化,不仅安全,而且可以减少麻醉科全麻成本。

Objective To study the low-flow anesthesia in the role of anesthesia to reduce costs.Methods Selective surgery patients with ASA Ⅰor Ⅱ grade level of general anesthesia,were treated with intravenous propofol 1% ＋ 0.005% remifentanil adjusted according to patients,isoflurane control amount was 1.2 MAC;AMSORB alcium lime was used as CO2 absorber.Experimental group：oxygen flow 350 ～ 400 ml/min.When FiCO2 continued to rise within 30 min to 8.5 mm Hg,it＇s an index to replace calcium lime.The control group：high-flow anesthesia,2 L/min,calcium lime was replaced when color changed at first using 70 ～ 90% of calcium lime.Isoflurane requirements（ml/h） and the time of PETCO2 needing to replace calcium lime were recorded.Results Time of calcium lime using for general anesthesia in the experimental group was（853.3 ± 204.8 minutes） and（498.9 ± 263.4 minutes） in the control group,with significant difference.Isoflurane using per hour,the experimental group（7.97 ± 2.56 ml/h） was much fewer than that in the control group（23.91 ± 3.04 ml/h）.Conclusion The low-flow anesthesia in application of anesthesiology deaprtment can greatly reduce inhaled anesthetic drugs in patients with reduced spending,and within 30 minutes FiCO2 continues to rise to more than 8.5 mm Hg as an index to replace calcium lime,it would not make changes of ETCO2,HR,MAP,which is safe and can reduce the cost of general anesthesia.