腹部不同手术方式七氟醚复合瑞芬太尼麻醉维持的实践分析

Research on sevoflurane combined with remifentanil anesthesia inabdominal surgeries

目的:观察开腹与腹腔镜手术以七氟醚复合瑞芬太尼维持的麻醉及复苏效果。方法:腹部手术60例,每组各30例。(1)记录患者的七氟醚总吸入时间、肌松药用量、呼气末七氟醚浓度;(2)记录围术期BP、HR及停药后5 min、呼吸恢复时呼气末七氟醚浓度;记录手术结束至呼吸恢复、呼唤睁眼与气管导管拔出的时间。结果:所有患者均无意外和不良事件发生。(1)开腹组七氟醚总吸入时间[(157.20±47.28)]min长于腹腔镜组[(73.50±11.23)]min(P<0.05),两组肌松药用量比较无统计学差异(P>0.05);(2)两组各时间点血压、心率比较无统计学差异(P>0.05);七氟醚术中呼气末麻醉药平均浓度比较,无统计学差异(P>0.05),均接近成人1.0MAC。开腹组停药后5 min、呼吸恢复时呼气末麻醉药浓度为(0.75±0.11)%及(0.27±0.08)%,对比腹腔镜组的(0.83±0.09)%及(0.28±0.10)%,无统计学差异(P>0.05)。结论:七氟醚复合瑞芬太尼行麻醉维持,具有术中维持稳定,术后复苏安全快速等特点,可用于常规开展的腹部手术中,建议临床推广使用。

Objective To observe the anesthesia and recovery results of sevoflrane and remifentanil combined anesthesia in open or laparoscopie surgeries. Methods 60 cases of ordinary surgeries from the department of gynecology and general surgeries were included in this study with 30 cases in each group. （1）recording total sevoflurane inhalation time, muscular relaxant amount, end tidal sevoflurane concentration; （2）recording BP, HR at 10 rain after induction,operation staring and ending,ventilation recovery, opening eye and extubation period;also sevoflurane concentration 5 min after stopping medicine and ventilation recovery;recording time period between surgery ending and autonomous respiration recovery, eye opening and extubation. Results No any adverse events happen in each patient.the sevoflurane inhalation time in open surgery group was （157.20 ± 47.28） rain, longer than that of laparoseopic surgeries group （73.50±11.23）min （P 〈 0.05）, we had seen no statistical significance in all other index observed （P〉 0.05）. Conclusion Sevoflurane combined remifentanil anesthesia can achieve stable intra-operative maintenance and rapid postoperative recovery quality, we suggest the widespread usage of it in clinic.