地氟醚在循环紧闭麻醉中的药代动力学

Pharmacokinetic Property of Desflurane in the Minimal Flow Closed circuit Anesthesia

目的 了解地氟醚在最低流量循环紧闭麻醉中药代动力学的临床表现。 方法 ５０例麻醉分级（ＡＳＡ） Ⅰ～Ⅱ级全麻下的择期手术病人。麻醉诱导采用咪唑安定、芬太尼、琥珀胆碱。气管插管后开始１０ ｍ ｉｎ 氧流量为４ Ｌ／ｍ ｉｎ，行间歇正压控制呼吸，地氟醚挥发罐浓度（ＦＤ）８％ 。此后关闭回路，氧流量０．２０～０．３５Ｌ／ｍ ｉｎ，地氟醚ＦＤ １０％ ～１２％ 。维持地氟醚的肺泡浓度（ＦＡ）在６％ ±０．１％ 。间断给予维库溴胺维持肌肉松弛。 结果 地氟醚ＦＡ 达６％ 和ＦＡ／ＦＩ（吸入浓度）达０．９，分别为４．９±０．８ ｍ ｉｎ 和１２．４±０．２ ｍ ｉｎ，并能维持在０．９０～０．９５。麻醉停止后，５．７±２．４ ｍ ｉｎ 恢复自主呼吸，拔管时间９．７±０．８ ｍ ｉｎ。麻醉中脉搏血氧饱和度均１００％ ，吸入氧浓度≥８０％ 。 结论 地氟醚的低组织溶解特性使其麻醉诱导和麻醉恢复快，麻醉调控性强。地氟醚的药代动力学特性使其能安全、有效地在最低流量循环紧闭麻醉中使用。

To study the clinical pharmacokinetic property of desflurane in minimal flow closed circuit anesthesia \ Methods\ The study was carried out on fifty adult(ASA ⅠandⅡ) patients scheduled for surgical procedures \ All patients were induced by midazolam, fentanyl and succinycholine \ After tracheal intubation, all patients were anesthetized with closed circuit anesthesia, which received delivered concentration(F\-D) of 8% desflurane in the fresh flow of 4 L/min in the first ten minutes, then increased F\-D to 10%～12% in the inflow reduced to 0 20～0 35 L/min after the initial ten minutes \ The end tidal concentration(F\-A) of desflurane was maintained in 6%±0 1% \ During anesthesia, vecuronium was given as necessary \ Results\ The F\-A of 6% desflurane was obtained in 4 9±0 8 min \ The ratio of F\-A and inspired concentration of desflurane(F\-I) reached 0 9 after 12 4±0 2 min, then was maintained in 0 9～0 95 \ After discontinuation of anesthesia, the time of spontaneous breath recovery and extubation was 5 7±2 4 and 9 7±0 8 min respectively \ During anesthesia, SaO\-2 of patients was maintained in 100% and inspired O\-2 concentration was all above 80% \ Conclusion\ The low solubility of desflurane favors its rapid induction and its precise control of anesthesia depth \ The property of desflurane pharmacokinetics facilitates its effective safe use in minimal flow closed circuit anesthesia \;