七氟醚-舒芬太尼靶控麻醉对脊柱手术患者发生谵妄的影响

Effect of Sevoflurane-sufentanil Combined Anesthesia by TCI on the Postoperative Delirium in Patients Undergoing Spine Surgery

目的评价七氟醚-舒芬太尼靶控麻醉对脊柱手术患者发生谵妄的影响.方法拟行脊柱手术患者200例,年龄18～64岁,ASA I或II级.采用随机数字表法,将患者随机分为2组(n=100):七氟醚-舒芬太尼手控麻醉组(MCI组)和七氟醚-舒芬太尼靶控麻醉组(TCI组).麻醉诱导:TCI组靶控输注舒芬太尼效应室浓度Ce 0.50 ng/mL,MCI组静脉注射舒芬太尼0.5μg/kg;2组静脉注射依托咪酯0.3 mg/kg,顺苯磺阿曲库铵0.15 mg/kg,气管插管行机械通气,VT 10 mL/kg,RR 12~15次/min.麻醉维持:TCI组呼气末七氟醚靶浓度1%～2%,舒芬太尼效应室浓度Ce 0.2～0.3 ng/mL;MCI组吸入七氟醚浓度1%～3%,间断静脉注射舒芬太尼10μg/次.2组均静脉输注顺苯磺阿曲库铵0.1 mg/(kg.h),术中维持PETCO230～40 mmHg(1 mmHg=0.133 kPa),HR、MAP波动幅度不超过术前访视时基础值的20%.记录血管活性药物的使用情况、麻醉恢复情况、术后谵妄发生情况.结果与MCI组比较,TCI组术中使用去氧肾上腺素、艾司洛尔的患者例数少;麻醉恢复期睁眼时间、拔管时间、清醒时间缩短,出现呛咳/躁动、使用硝酸甘油的患者例数少;术后谵妄发生率低(P<0.05).结论七氟醚-舒芬太尼靶控麻醉用于脊柱手术,术中血液动力学稳定,术后麻醉恢复快、质量好,术后谵妄的发生机率小,与提高麻醉质量预防术后谵妄有关.

Objective To investigate the effect of sevoflurane-sufentanil combined anesthesia by TCI on the postoperative delirium in patients undergoing spine surgery. Methods Two hundreds ASA I or II patients, aged 18-64 yr, scheduled for spine surgery, were randomly divided into 2 groups （n =100 each） ： sevoflurane-sufentanil combined anesthesia with target controlled inhalation and infusion group （group TCI） and manually controlled inhalation and infusion group （group MCI）. Anesthesia was induced with target-controlled infusion of sufentanil （ target effect-site concentration set at 0.5 ng/mL） in group TCI; iv injection sufentanil 0.5 /xg/kg in group MCI ; iv injection of etomidate 0.3 mg/kg in both groups, As soon as the patients lost consciousness, tracE^al intubation was facilitated with 0.15 mg/kg cisatracurium besylate. The patients were mechanically ventilated. Anesthesia was maintained with target controlled inhalation of sevoflurane （target end-tidal concentration 1%-2%） , target-controlled infusion sufentanil （target effect-site concentration 0.2-0.3 ng/mL） in group TCI; inhalation ofsevoflurane （1%-3%） and ivinjectionofsufentanil （10 I^g/time） in groupMCI; and iv infusion of cisatracurium besylate 0.1 mg/（kg.h） in both groups. BIS value was maintained at 40-60, Changes of HR and MAP were less than 20% of the baseline value in both groups. The use of vasoactive drugs, the time of anesthesia recovery, and delirium were recorded. Results The amount of phenylephrine and esmolol were significantly lower, the awakening time, extubation time and consciousness time were significantly shortened, Bucking and/or restlessness during recovery and the amount of nitroglycerin were significantly were lower, the incidence of postoperative delirium was significantly lower in group TCI than in group MCI （P 〈 0.05 ）. Conclusion Compared with manually controlled inhalation and infusion with target controlled inhalation and infusion, sevoflurane-sufentanil combined anesthesia provide hemodynamic stability and fast recovery in the spine surgery. It is an effective measure to decrease the incidence of postoperative delirium by improving anesthetic quality.