不同麻醉下脊柱侧弯矫形术患者术中唤醒试验的比较

Comparison of intraoperative wake-up test in patients undergoing scoliosis surgery with different anesthesia methods

目的比较不同麻醉下脊柱侧弯矫形术患者术中唤醒试验。方法选择拟行脊柱侧弯矫形术患者40例，年龄13～18岁，性别不限，BMI〈30kg／m^2，ASA分级I级。采用随机数字表法，将患者随机分为2组（n=20）：异丙酚复合舒芬太尼组（P组）和靶控吸入七氟醚复合舒芬太尼组（S组）。麻醉维持时S组靶控吸入七氟醚，呼气末靶浓度0．8％～1．5％；P组靶控输注异丙酚，血浆靶浓度3～5μg／ml，两组均靶控输注舒芬太尼，效应室靶浓度0．2—0．3ng／ml。唤醒试验前停止输注顺阿曲库铵，下调舒芬太尼效应室靶浓度至0．1ng／ml；5rain后，S组停用七氟醚，P组停用异丙酚；5min后开始唤醒试验。于唤醒试验前、唤醒成功时及唤醒成功后10min（T0～2）时记录MAP和HR，记录唤醒时间、唤醒期间呛咳、躁动的发生情况，术后随访记录患者术中知晓的发生情况。结果与P组比较，S组术中唤醒时间短（P〈0．05）。两组术中唤醒期间MAP和HR均在正常范围内，两组比较差异无统计学意义（P〉0．05）。所有患者术中唤醒试验均成功，术中唤醒期问无一例发生呛咳、躁动及术中知晓。结论靶控吸入七氟醚复合舒芬太尼可安全有效地用于脊柱侧弯矫形术患者术中唤醒试验，且唤醒时间短于靶控输注异丙酚复合舒芬太尼麻醉，更适用于术中唤醒试验。

Objective To compare the intraoperative wake-up test in patients undergoing scoliosis surgery with different anesthesia methods. Methods Forty ASA i patients aged 13-18 yr with body mass index 〈 30 kg/m2 scheduled for scoliosis surgery were randomly divided into 2 groups （ n = 20 each） ： propofol combined sufentanil anesthesia group （group P） and sevoflurane combined sufentanil anesthesia group （group S）. Anesthesia was induced with target-controlled infusion of snfentanil（target effect-site concentration 0.5 ng/ml）, and iv injection of etomidate 0.3 mg/kg in both groups. Tracheal intubation was facilitated with 0.15 mg/kg cisatracurium when patients lost consciousness. The patients were mechanically ventilated. Anesthesia was maintained with ＇target-controlled inhalation of sevoflurane （target end-tidal concentration 0.8 %-1.5 % ） in group S, and target-controlled infusion of propofol （target plasma concentration 3-5 μg/ml） in group P, and target-controlled infusion of sufentanil （target effect-site concentration 0.2-0.3 ng/ml）, and iv infusion of cisatracurium 0.1 mg·kg^-· h^-1 in both groups. BIS value was maintained at 40-60. Cisatracurium administration was terminated and target effect-site concentration of sufentanil decreased to 0.1 ng/ml before wake-up test, 5 min later, sevoflurane and propofol administration were terminated, and 5 rain later wake-up test was performed. MAP and HR were recoreded during wake-up test. The wake-up time and advers effect （bucking, restlessness and awareness）were recorded. Results The wake-up time was significantly shorter in group S than in group P（ P 〈 0.05）. MAP and HR were in normal range during wake-up test in both groups, and bucking, resdessness and awareness were not found in both groups. Conclusion Target-controlled inhalation of sevoflurane combined with sufentanil can be safely and effectively used for intraoperative wake-up test in patients undergoing scoliosis surgery, and the wake-up time is shorter than that with propofol combined sufentanil, and it is an apporiate anesthetic technique for the intraoperative wake-up test.