七氟醚全身麻醉保留自主呼吸在输尿管下激光碎石术的应用

Application of sevoflurane anesthesia under spontaneous respiration in laser lithotripsy

目的探讨全程七氟醚全身麻醉保留自主呼吸在输尿管下激光碎石术的可行性和安全性。方法选择ASA分级Ⅰ～Ⅱ级择期在全身麻醉下实施输尿管下激光碎石术的患者60例,随机分为自主通气组(S组,n=30)和机械通气组(M组,n=30)。S组应用七氟醚诱导,待下颌松弛后插入喉罩,保留自主呼吸并维持至术毕;M组应用七氟醚及维库溴铵全麻诱导后插入喉罩并予以机械通气。记录两组患者诱导时间,清醒时间及麻醉诱导前(T0)、喉罩置入即刻(T1)、喉罩置入后3min(T2)、喉罩置入后30min(T3)、喉罩拔除即刻(T4)、喉罩拔除后20min(T5)的血流动力学及经皮氧饱和度(SpO2)、呼末二氧化碳(PetCO2)。同时记录吸气末七氟烷浓度(CINSEV)和呼气末七氟烷浓度(CETSEV)并抽取动脉血行血气分析。结果 S组和M组各有2例和3例患者因中转进腹退出研究。两组患者均获得满意的插管条件,但S组的麻醉诱导时间明显长于M组,两组的差异有统计学意义(t=28.43,P<0.05),且喉罩置入前所需的的CENSEV明显高于M组,S组间清醒时间短于M组,诱导期及术中PetCO2高于M组,两组的差异均有统计学意义(t分别=27.61、2.78、4.34、3.10,P均<0.05),但均在允许范围内。结论七氟醚全身麻醉保留自主呼吸可提供充分的氧供,不引起危害性的二氧化碳潴留。但需要较高的吸气末七氟烷浓度获得满意的插管条件。术中及术后血流动力及呼吸功能均能维持接近生理状态,在肌松要求不高的手术全麻中可免用机械通气。

Objective To explore the safety and feasibility of application of sevoflurane anesthesia under spontaneous respiration in laser lithotripsy.Methods Sixty ASAⅠ-Ⅱ patients were randomly divided into two groups（SR group and MV group）.SR group（n=30） induced by sevoflurane,the LMA was inserted when the facial muscles relaxed,maintained spontaneous respiration in the operation;MV group（n =30） induced by sevoflurane and vecuronium.After anesthesia induction,the LMA was inserted and treated with mechanically ventilated.SBP,DBP,HR and SPO2 were monitored at different time points：before anesthesia（T0）,LMA was inserted（T1）,3 minutes after LMA（T2）,30 mins after LMA（T3）,drawing cannulation（T4）,20 mins after drawing cannulation（T5）.Inhalation of sevoflurane with end-tidal concentration,blood gas were analyzed.Results There were 3 patients of group S and 2 patients of group M were removed.Both groups obtained satisfactory conditions for intubation,but the time of anesthesia induction of group S was remarkably longer than group M with significant difference（t=28.43,P0.05）;inhalation of sevoflurane with end-tidal concentration before intubation in group S was higher than that in group M;the awakening time in group S was shorter than that in the group M;the PetCO2 was higher than that of the group M during anesthesia induction and operation（t=27.61,2.78,4.34,3.10,P0.05）,and were in the normal range.Conclusions Application of sevoflurane anesthesia under spontaneous respiration provides with sufficient oxygen and do not cause hypercapnia;but inhalation of sevoflurane with end-tidal concentration should provide very favorable conditions for intubation.Haemodynamics and respiratory function can keep physiological state in the operation and post operation.The operation with low requirements to muscle-relaxing effects can avoid mechanical ventilation.