七氟醚和丙泊酚不同麻醉方案用于腹腔镜手术的临床研究和经济效益学比较

Clinical study and pharmacoeconomic comparison on different anesthetic solution of sevoflurane and propofol for laparoscopic surgery

目的比较七氟醚和丙泊酚不同麻醉方案用于腹腔镜手术的临床研究和经济效益。方法 2011年1月—2013年12月阳谷县中医院收治的行腹腔镜手术治疗的患者200例,随机分为七氟醚组(66例)、丙泊酚组(67例)和联合组(67例)。分别给予七氟醚全程吸入麻醉、丙泊酚靶控输注麻醉和静脉注射丙泊酚诱导–吸入七氟醚维持麻醉3种不同麻醉方案。比较3组患者麻醉和苏醒质量、麻醉费用、不良反应发生率,同时于术前、术后3 d检测免疫反应指标。结果七氟醚组意识消失时间显著短于联合组,丙泊酚组高于联合组,两组比较差异有统计学意义(P<0.05);丙泊酚组意识消失时间、气管插管时间、定向力恢复时间均显著长于七氟醚组、联合组,两组比较差异有统计学意义(P<0.05)。七氟醚组、丙泊酚组麻醉诱导费用、麻醉维持费用、总费用及每分钟费用均显著高于联合组,差异有统计学意义(P<0.05);丙泊酚组麻醉诱导费用、麻醉维持费用、总费用及每分钟费用均显著高于七氟醚组,但追加麻醉费用低于七氟醚组,两组比较差异有统计学意义(P<0.05)。3组患者术后3 d CD4、CD8、CD4/CD8与同组术前比较差异无统计学意义,且3组患者CD4、CD8、CD4/CD8水平差异亦无统计学意义。结论在麻醉及麻醉恢复质量相近的情况下,腹腔镜手术麻醉方案中,静脉注射丙泊酚诱导–吸入七氟醚维持麻醉是最为经济的方案,值得临床推广应用。

Objective To compare the clinical efficacy and pharmacoeconomic analysis of different anesthetic solution of sevoflurane and propofol for laparoscopic surgery. Methods The patients （200 cases） accepted laparoscopic surgery in the Traditional Chinese Medicine Hospital of Yanggu County from January 2011 to December 2013 were randomly divided into sevoflurane （66 cases）, propofol （67 cases）, and combined （67 cases） groups. The patients in the three groups were given the inhalation of sevoflurane anesthesia, target-controlled infusion of propofol anesthesia, and iv propofol for induction of anesthesia-inhalation of sevoflurane for maintenance of anesthesia. The quality of anesthesia and awakening, cost of anesthesia, incidence of adverse drug reactions were compared in the three groups. At the same time, the indexes of immune response in preoperative and postoperative 3 d were detected.Results Consciousness disappearing time in sevoflurane group was significantly shorter than that in the combined group, while the time in the propofol group was longer than that in the combined group, and there were differences between the two groups （P 〈0.05）.Consciousness disappearing time, endotracheal intubation time, directional force recovery time in the propofol group were significantly longer than those in the sevoflurane and combined groups, and there were differences between the two groups （P〈0.05）. Anesthesia induction costs, anesthesia maintenance costs, total cost, and per minute cost in the sevoflurane and propofol groups were significantly higher than those in the combined group, and the difference was statistically significant （P〈0.05）. Anesthesia induction costs, anesthesia maintenance costs, total cost, and per minute cost the in propofol group were significantly higher than those in the sevoflurane group, but additional anesthesia cost was lower than that in the sevoflurane group, and there were differences between the two groups （P〈 0.05）. CD4, CD8, and CD4/CD8 in the three groups were no statistically significant difference in 3 d before and after surgery. The difference of CD4, CD8, and CD4/CD8 in the three groups also had no statistical significance. Conclusion In the case of similar quality of anesthesia and anesthesia recovery, iv propofol for the induction of anesthesia-inhalation of sevoflurane for maintenance of anesthesia is the most economical solution, which is worthy of clinical popularization and application.