采用七氟烷或丙泊酚／瑞芬太尼全身麻醉行妇科手术临床研究

Clinical study of sevoflurane or propofol/remifentanil general anesthesia undergoing gynecological surgery

目的观察七氟烷吸入麻醉或丙泊酚／瑞芬太尼全凭静脉麻醉行妇科手术的临床麻醉效果。方法80例行妇科择期手术患者按随机数字表法分入七氟烷组和丙泊酚／瑞芬太尼组，每组40例。两组患者皆采用静脉药物咪达唑仑、丙泊酚、舒芬太尼和罗库溴铵快速诱导。气管插管成功后七氟烷组吸入七氟烷，丙泊酚／瑞芬太尼组静脉靶控输注丙泊酚和瑞芬太尼，维持脑电双频指数在40～60，记录患者血压、心率。手术结束，停用所有麻醉药物，记录两组患者清醒时间、拔除气管导管时间、定向力恢复时间，麻醉恢复期躁动、术后24h内恶心呕吐发生率，以及麻黄碱、阿托品或乌拉地尔应用情况。结果两组意识恢复时间、拔除气管导管时间及定向力恢复时间比较差异无统计学意义（P〉0．05）；七氟烷组阿托品和麻黄碱应用较丙泊酚／瑞芬太尼组减少[7．5％（3／40）比22．5％（9／40）、20．0％（8／40）比32．5％（13／40）]，差异有统计学意义（P〈0．05），而乌拉地尔应用较丙泊酚／瑞芬太尼组增加[22．5％（9／40）比2．5％（1／40）]，差异有统计学意义（P〈0．01），两组麻醉恢复期躁动发生率和术后24h内恶心呕吐发生率比较差异无统计学意义（P〉0．05）。结论采用七氟烷吸入麻醉或丙泊酚／瑞芬太尼全凭静脉麻醉皆可提供满意的临床麻醉效果。

Objective To study the effect of sevoflurane or propofol/remifentanil general anesthesia undergoing gynecological surgery. Methods A total of 80 patients scheduled for selected gynecological surgery were divided into sevoflurane group or propofol/remifentanil group by random digits table method and 40 cases in each group. The induction of anesthesia was conducted with midazolam, propofol, sulfentanil, and rocuronium. After tracheal intubation, anesthesia was maintained with sevoflurane in sevoflurane group, and with propofol/remifentanyl target-controlled infusion in propofol/remifentanil group. Bispectral index was monitored in each group, and which was maintained 40 - 60. Blood pressure and heart rate was observed. At the end of operation, all anesthetics were discontinued, and the time of consciousness recovery, tracheal extubation, orientation was recorded. The incidence of agitation,nausea and vomiting within 24 h after surgery and the use of rescue drugs such as epinephrine, atropine or urapidil was recorded. Results No statistically significant difference was observed with respect to the time of consciousness recovery, tracheal extubation, orientation between two groups （P 〉 0.05 ）. The use of atropine and epinephrine in sevoflurane group was lower than that in propofol/remifentanil group [7.5%（3/40） vs. 22.5%（9/40）, 20.0%（8/40） vs. 32.5%（13/40） ], and there was significant difference（P 〈 0.05 ）, and the use of urapidil in sevoflurane group was higher than that in propofol/remifentanil group [22.5% （9/40） vs. 2.5% （1/40）],and there was significant difference （P 〈 0.01 ）. There was no statistically significant differences with respect to the incidence of agitation, nausea and vomiting within 24 h after surgery between two groups （P 〉 0.05 ）. Conclusion Propofol/remifentanil and sevoflurane both provide satisfactory anesthesia for gynecological surgery.