七氟烷与丙泊酚两种麻醉于门诊乳房肿块切除手术的比较

Comparison of sevoflurane inhalation anesthesia with propofol intravenous anesthesia in outpatient breast mass surgery

目的:七氟烷和丙泊酚两种麻醉用于门诊乳房肿块切除手术的比较。方法:选择ASAⅠ～Ⅱ级拟行乳房肿块切除的门诊手术患者60例,随机分为两组,每组30例:丙泊酚组(Ⅰ组)和七氟烷组(Ⅱ组),分别采用1.5～2.0 mg/kg的丙泊酚静脉诱导和8%的七氟烷多次自主深呼吸吸入诱导。术中维持:Ⅰ组4～6 mg/(kg.h)的丙泊酚静脉持续输注;Ⅱ组2%～3%浓度的七氟烷吸入维持。观察记录两组患者麻醉中的血流动力学变化,记录睫毛反射消失时间、意识恢复时间,并观察随访注射痛、呼吸暂停、体动、术中知晓、恶心呕吐等不良反应。结果:两组患者诱导后的平均动脉压(MAP)和心率(HR)较基础值均明显下降(P<0.05),Ⅰ组患者MAP较Ⅱ组下降明显(P<0.05);两组睫毛反射消失时间的差异无统计学意义(P>0.05),但Ⅱ组的清醒时间明显短于Ⅰ组(P<0.05);Ⅱ组无注射痛,其术中体动反应发生率明显低于Ⅰ组(P<0.05),Ⅰ组发生呼吸暂停2例,两组均未发生术中知晓及恶心呕吐。结论:与丙泊酚静脉麻醉相比,七氟烷吸入麻醉用于门诊乳房肿块切除术安全有效、可控性强、不良反应少。

Objective： To compare the effect of sevoflurane inhalation anesthesia with propofol intravenous anesthesia in outpatient breast mass surgery. Methods： 60 patients of ASA physical status Ⅰ or Ⅱ, undergoing breast mass surgery in outpatient operating room, were randomly divided into two groups （n=30 each）： propofol group（ Ⅰ group）and sevoflurane group （ Ⅱ group）. Anesthesia was induced with intravenous infusion of 1.5-2.0 mg/kg propofol or 8% sevoflurane in 100% oxygen at 6 L/min with spontaneous inhalation respectively. And anesthesia was maintained in 4-6 mg/（kg ·h） propofol by intravenous continuous infusion in Ⅰ group or inhalant concentration of 2%-3% sevoflurane in Ⅱ group. The changes of hemodynamic values during anesthesia were recorded. The time of abolition of eyelash reflex, consciousness recovery time, injection pain, apnea and, nausea or vomiting were investigated. And all patients were followed up postoperatively for adverse effects like intraoperative awareness. Results： MAP and HR were significantly decreased after induction of anesthesia compared with their basic values in two groups （P〈0.05）, MAP in the group I were significantly decreased than that in the group Ⅱ （P〈0.05）. There were no significant difference in the time of abolition of eyelash reflex between two groups （P〉0.05）. However, the consciousness recovery time in group Ⅱ were obviously shorter than those in group Ⅰ （P〈0.05）. No injection pain and less movement were observed in group Ⅱ （P〈0.05）. Two patients in group Ⅰ had apnea. There was no intraoperative awareness, nausea or vomiting in two groups. Conclusion： Compare with propofol intravenous anesthesia, sevoflurane inhalation anaesthesia is safer, more effective, more controllable and fewer side effects for outpatient breast mass surgery.