七氟醚复合丙泊酚靶控输注在甲状腺手术中应用

Sevoflurane inhalational combined with target controlled Propofol infusion in patients undergoing thyroidectomy

目的观察比较七氟醚与瑞芬太尼分别复合丙泊酚靶控输注对甲状腺手术患者血流动力学及术后恢复情况的影响,探讨七氟醚复合丙泊酚靶控输注用于甲状腺手术的安全性及有效性。方法择期拟行单纯甲状腺次全切除手术女性患者60例,ASAⅠ～Ⅱ级,年龄20～50岁,体重指数<30 kg/m2,随机分为两组(n=30),S组:七氟醚吸入麻醉复合丙泊酚靶控输注(效应室浓度3.0μg/mL);R组:瑞芬太尼静脉输注复合丙泊酚靶控输注(效应室浓度3.0μg/mL)。分别记录两组患者诱导前(T1)、插管前(T2)、插管后5 min(T3)及手术结束时(T4)的心率(HR)和平均动脉压(MAP),记录术后完全清醒时间(完全清醒是指患者自动性睁眼和指令性恢复)、术后24 h恶心呕吐(24 h PONV)及术中知晓发生率。结果两组均未发生术中知晓,术后完全清醒时间及术后24 h PONV发生率组间比较差异无统计学意义(P>0.05),S组麻醉诱导前后血流动力学更加稳定(P<0.05)。结论对接受甲状腺切除手术的患者,七氟醚与瑞芬太尼分别复合丙泊酚靶控输注,均可提供安全有效的麻醉,术后苏醒安全迅速,但七氟醚组血流动力学更稳定。

Objective To compare the effects of Sevoflurane or Remifentiail combined with target controlled Propofol infusion on the change of homodynamic and recovery in patients undergoing thyroidectomy.Methods 60 ASA Ⅰ-Ⅱ patients,aged 20-50 years,body mass index30 kg/m2,undergoing thyroidectomy,were randomly divided into 2 groups（n=30 each）： Sevoflurane group（S group） and Remifentiail group（R group）.S group was treated with Sevoflurane combined with target controlled propofol infusion（target plasma concentration 3.0 μg/mL）;R group was treated with Remifentiail combined with target controlled Propofol infusion（target plasma concentration 3.0 μg/mL）.Recorded HR and MAP in pre-induced（T1）,before tracheal intubation（T2）,5 min after tracheal intubation（T3） and immediately after completion of the operation（T4）,awake time,postoperative nausea and vomiting of patients were observed after operation.Results There was significant difference in HR and MAP at T2 between the two groups（P0.05）,but not at T1,T3 and T4.No significant difference in awake time and PONV between the two groups（P0.05）.Conclusion Sevoflurane or Remifentiail combined with target controlled Propofol infusion are all effective in inducing good anesthetic and ensuring rapid recovery,but the change of hemodynamic in S group is light than R group.