3种七氟烷吸入麻醉诱导方式的临床研究

Narcotic effect of inhalation anesthesia of sevoflurane induced by three different methods

目的探讨3种七氟烷吸入麻醉诱导方式的临床效果。方法诱导开始前，打开七氟烷挥发罐，根据分组情况不同，分别选定9％（A组、B组）和4％（C组），同时氧流量3 L/min预充连接管道。完成后，A组（肺活量呼吸法）嘱咐患者尽力呼气后，面罩紧密置于口鼻部，再尽力吸气，并且连续用肺活量呼吸方式呼吸数次；B组（潮气量呼吸法）将面罩紧密置于患者口鼻部，嘱咐患者正常呼吸；C组（逐渐增加浓度法）用4％七氟烷预充连接管道后，将面罩紧密置于患者口鼻部，嘱咐患者正常呼吸，每25秒增加七氟烷吸入浓度1．5％。设定潮气量为7～9 mL/kg ，呼吸频率为13次/min ，异丙酚60～90μg/kg · min静脉泵注射进行麻醉维持，同时可加用瑞芬太尼0．2～0．3μg/kg · min。结果 A组、B组和C组在不同时间点的收缩压、舒张压和平均压力都得到了抑制（P＜0．05），并且在时间点T3抑制效果显著（P＜0．01）。A组、B组和C组在不同时间点与心率变化和肌肉松弛效果无密切关联（P＞0．05）。结论通过实验得出3种不同浓度和吸入方式的七氟烷吸入诱导方式均能取得理想的临床效果，都体现出了七氟烷诱导快、刺激性小、对血流动力学影响较平稳的优点。

Objective To explore the narcotic effect of inhalational anesthesia of sevoflurane induced by three different methods .Methods Before anesthesia ,sevoflurane vaporizer was opened ,concentration of sevoflurane was set for 9% （A group ,B group） and 4% （C group） ,respectively ,and connecting pipes were prefilled by oxygen with flow speed for 3 L/min .Patients in A group （spirometry breathing method） were asked to exhale exhaustively ,then the mask was tightly placed on snout ,and after exhaustive inhalation ,patients were asked to breathe several times , taking spirometry breathing method .In B group （tidal volume breathing method） ,masks were closely placed on the snout of patients ,who then were asked to breathe normally .In C group （gradually increasing concentration meth-od） ,the masks were tightly placed on patients′snout ,and then the patients were asked to breathe normally ,and the inhalation concentration of sevoflurane was increased 1 .5% at 25 seconds interval .Anesthesia was maintained by setting tidal volume for 7-9 mL/kg ,respiratory rate for 13 times/min ,and intravenous infusion of propofol at 60-90 μg · kg -1 · min-1 ,while remifentanil was added at 0 .2-0 .3 μg · kg -1 · min-1 .Results In A ,B and C group , systolic ,diastolic and mean blood pressure were inhibited significantly at different time points （P〈0 .05） ,especially in time point T3 （P〈0 .01） ,and there was no significant difference of heart rate and muscle relaxant effects be-tween different time points in the three groups （P〉0 .05） .Conclusion All of the three different concentrations and inhalation induction methods of sevoflurane could obtain ideal clinical effect ,indicating the advantages of sevoflu-rane ,such as fast induction ,small stimulus and stable hemodynamics effects .