氟烷、异氟醚和七氟醚对拔除气管插管后患者通气功能和意识水平的影响

Influence of Halothane,Isoflurane,and Sevoflurane on the Ventilation Function and Consciousness Level after Tracheal Intubation

目的比较氟烷、异氟醚和七氟醚3种挥发性麻醉剂对拔除气管插管后通气功能和意识水平的作用。方法选取2010年4月—2011年7月17例接受中耳整复术的患者,根据术中使用麻醉剂不同,分为氟烷组6例、异氟醚组5例和七氟醚组6例,监测并比较3组患者在拔除气管插管后不同时间段的身体状况,呼吸功能,麻醉剂的血液、肺泡浓度和意识水平的恢复情况。结果 (1)身体状况:3组患者在拔除气管插管后20 min和2 h时的平均动脉压(MAP)、心率和膀胱温度比较,差异均无统计学意义(P>0.05)。(2)呼吸功能:3组患者在拔除气管插管后20min时动脉血二氧化碳分压(PaCO2)、每分钟静息通气量(VE)、呼吸频率(RR)、VE/PaCO2和每分钟二氧化碳呼出量(VCO2)比较,差异均无统计学意义(P>0.05)。但在2 h时PaCO2、VE、RR、VE/PaCO2和VCO2比较,差异均有统计学意义(P<0.05);且氟烷组的PaCO2较异氟醚组和七氟醚组均高,VE、RR、VE/PaCO2和VCO2均较异氟醚组和七氟醚组低,差异有统计学意义(P<0.01)。(3)麻醉剂的血液浓度和肺泡浓度:3组患者在拔除气管插管后15 min肺泡内麻醉药物浓度(CAAnesth)/最小肺泡有效浓度(MAC)的比较,差异有统计学意义(P<0.05);且氟烷组的CAAnesth/MAC较异氟醚组和七氟醚组均高,差异有统计学意义(P<0.05)。(4)意识水平恢复情况:3组患者在拔除气管插管后30 min、60 min和90 min时意识水平恢复情况比较,差异无统计学意义(P>0.05)。结论氟烷较异氟醚和七氟醚在术后意识恢复方面无明显区别,但在通气功能恢复方面更快、更具优势,值得临床推广。

Objective To investigate the effects of three volatile anesthetics （halothane, isoflurane, and sevoflu- rane） on postanesthetic ventilation and levels of consciousness. Methods 17 patients from April 2010 to July 2011 underwent tympanoplasty were divided into halothane group （6 cases ）, isoflurane group （5 cases ） and sevoflnrane group （6 cases ）. Physical condition, ventilation function, anesthetics concentration in blood and pulmonary alveoli and consciousness level of the patients after tracheal extubation were compared between the three groups. Results （ 1 ） Physical condition ： MAP, heart rate and bladder temperature 20min and 2h after tracheal extubation between the three groups showed no statistically significant differ- ence （ P 〉 0. 05 ） . （2） Ventilation function： PaCO2, VE, RR, VE/PaCO2 and VCO2 20 min after tracheal extnbation be- tween the three groups showed no statistically significant difference （ P 〉 0. 05 ）, but PaCO2, VE, RR, VE/PaCO2 and VCO2 2 h after tracheal extubation between the three groups showed statistically significant difference （ P 〈 0. 05 ） . Among them, the PaCO2 in halothane group was significantly higher than isoflurane group and sevoilurane group （P 〈 0. 01 ） . The VE, RR, VE/ PaCO2 and VCO2 in halothane group was significantly lower than isoflurane group and sevoflurane group （P 〈 0.01 ） . （3） An- esthetics concentration in blood and pulmonary alveoli： The CAAnesth/MAC 15 min after tracheal extubation between the three groups showed statistically significant difference （ P 〈 0. 05 ） , and the CAAnesth/MAC in halothane group was significantly high- er than isoflurane group and sevoflurane group （ P 〈 0.05 ） . （4） Consciousness level ： The recovery of consciousness level 30 min, 60 min and 90 min after tracheal extubation between the three groups showed no statistically significant difference （ P 〉 0. 05 ） . Conclusion Compared with isoflurane and sevoflurane, halothane shows no significant difference on the recovery of consciousness, but can provide clinical advantages over halotbane on postanesthetic ventilation and recoveryof levels of con- sciousness.