七氟烷或丙泊酚联合瑞芬太尼用于肝癌射频消融术全麻苏醒过程的比较

Comparison of awake time from anesthesia with sevoflurane/remifentanil and propofol/remifentanil in patients undergoing radiofrequency ablation of liver tumor

目的比较七氟烷、瑞芬太尼静吸复合麻醉与丙泊酚、瑞芬太尼靶控输注（TCI）全凭静脉麻醉行肝癌射频消融术后患者苏醒的过程，为临床合理应用提供参考。方法40例年龄38～60岁，ASAⅠ～Ⅱ级择期行肝癌射频消融术患者随机分为S、P两组（n=20），自诱导至术毕两组均以2～4ng／ml效应室TCI输注瑞芬太尼，S组持续吸入七氟烷，P组TCI输注丙泊酚麻醉维持。麻醉过程中脑电双频指数（BIS）监测麻醉深度，记录停药后患者苏醒时间、拔管时间、拔管后1h镇静评分（OAAS）和疼痛的视觉模拟评分（VAS）。结果苏醒时间和拔管时间P组明显长于S组（P〈0．01）。拔管后OAAS评分、VAS评分两组比较差异无统计学意义。结论七氟烷、瑞芬太尼静吸复合麻醉比丙泊酚、瑞芬太尼靶控输注（TCI）全凭静脉麻醉用于肝癌射频消融术可控性更佳，术后苏醒更为迅速。

Objective To comparison of awake time from anesthesia with sevoflurane/ remifentanil and propofol/remifentanil in patients undergoing radiofrequency ablation of liver tumor. Methods Forty ASA Ⅰ - Ⅱ patients,38 - 60 years old, sheduled for radiofrequency ablation of liver tumors were randomly divided into two groups, group P and group S, with each 20 eases. All patients received a target - controlled effect - compartment concentration of 2 - 4 ng/ml remifentanil from induction of anesthesia to the endpoint of surgery. Anesthesia was maintained with sevoflurane after tracheal intubation with propofol in group S, and maintained with propofol target - controlled infusion in group P. BIS were monitored during operation. After the operation, the awake - time, extubate - time were recorded. Sedation scores（OAAS） and pain scores（VAS） were also analyzed. Results Awake - time was significantly shorter in group S than that in group P（ P 〈 0.05 ）. Sedation scores （OAAS） and pain scores（VAS） were not different between the two groups. Conclusions Sevoflurane/remifentanil is more rapid early recovery than porpofol/reminfentanil for patients undergoing radiofrequency ablation of liver tumor.