七氟醚减量法对老年患者腹腔镜下胆囊切除术苏醒时间的影响

Effect of sevoflurane titration anesthesia on recovery time in laparoscopic cholecystectomy of eldly patients

目的观察七氟醚减量法对行腹腔镜下胆囊切除术的老年患者苏醒时间的影响。方法择期腹腔镜下胆囊切除术老年患者45例，美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级，年龄65岁～80岁，采用随机数字表法随机分为3组，每组15例：单纯七氟醚组（Ⅰ组），皮肤缝合结束时停止吸入七氟醚，增加氧流量至10Umin；七氟醚丙泊酚复合组（Ⅱ组），腹膜缝合结束时停止吸入七氟醚，增加氧流量至10L／min，静脉注射丙泊酚0．5mg／kg；七氟醚滴定组（Ⅲ组），关闭腹膜即刻，降低七氟醚浓度至0．5最低肺泡有效浓度（minimal alveolar concentration，MAC），缝合皮肤结束时停止吸入七氟醚，增加氧流量至10L／min。观察苏醒时间（自皮肤缝合结束至患者接受指令睁开眼睛时间）、脑电双频指数（bispectral index，BIS）值达90的时间及生命体征监测指标[平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR）、脉搏血氧饱和度（pulse oxygen saturation，Sp02）和呼气末二氧化碳分压（partial pressure of end-tidal carbon dioxide，PETCO2）]。结果Ⅱ、Ⅲ组患者停止七氟醚吸入后的苏醒时间[Ⅱ组（12．20±1．97）min，Ⅲ组（10．33±1．54）min]及BIS值恢复至90的时间[Ⅱ组（15．07±2．25）min，111组（12．20±1．74）min]均显著短于Ⅰ组[苏醒时间（14．87±2．77）min，BIS值恢复至90的时间（17．41±2．75）min]（P〈0．05），Ⅲ组又显著短于Ⅱ组（P〈0．05）。3组在气管拔管前即刻各项生命体征（MAP、HR、P水O：及SpO2）差异均无统计学意义（P〉0．05），苏醒后各时点的Steward评分比较差异无统计学意义（P〉0．05）。结论老年患者腹腔镜下胆囊切除术麻醉苏醒阶段采用七氟醚逐步减量法，缩短患者术后苏醒时间，并且不会影响麻醉后苏醒质量。

Objective To study the effect of sevoflurane titration anesthesia on recovery time in laparoscopic cholecystectomy of eldly patient. Methods Forty-five patients （ASA Ⅰ - Ⅱ ） underwent laparoscopic cholecystectomy and were randomly divided into 3 groups（n=15 ）. The patients in group I were stopped inhaling sevoflurane after skin closure and oxygen flow was increased to 10 L/min. The patients in group Ⅱ were stopped inhaling sevoflurane after peritoneum suture, and oxygen flow was increased to 10 L/min, and propofol （0.5 mg/kg） was intravenously injected. For group Ⅲ, sevoflurane was decreased to 0.5 min alveolar concentration （MAC） at the end of peritoneum suture and was stopped after skin closure, and oxygen flow was increased to 10 L/min. The recovery time （from finishing skin closure to opening eyes under orders）, the time of bispectral index（BIS） reached to 90, and vital signs[ mean arterial pressure（MAP）, heart rate（HR ）, pulse oxygen saturation（SpO2）, and partial pressure of end-tidal carbon dioxide（PETCO2）] were recorded. Results The recovery time[group Ⅱ （12.20±1.97） min, group 111（10.33±1.54） mini and the time of BIS reached to 90 [group Ⅱ （15.07±2.25） rain,group m （12.20±1.74） mini in groups 1[ and m were significantly shorter than those in group I [recovery time （14.87±2.77） min, time of BIS reached to 90 （17.41±2.75） mini （P〈0.05）, group m was also significantly shorter than that in group l/ （P〈0.05）. But there were no statistically differences in the indicators of vital signs before extubation in all groups （P〉0.05）. Conclusions Sevoflurane titration anesthesia can reduce the impact of combined drug administering, shorten the recovery time after surgery and keep the recovery quality in laparoscopic cholecystectomy.