不同浓度七氟烷吸入诱导对择期神经外科患者血流动力学的影响观察

Observation on the Effect of Different Concentrations of Sevoflurane Inhalation Induction on Hemodynamics of Patients in Neurosurgery Department

目的观察不同浓度七氟烷吸入诱导对神经外科患者血流动力学的影响。方法选择笔者医院神经外科2013年1月～2015年4月收治的90例手术患者作为研究对象，采用数字表法随机分为A、B、c3组，各30例。A组七氟烷吸入浓度为8％，B组为4％，C组为首先吸入8％七氟烷，之后间隔2min减少2％并维持在4％，比较3组诱导前、气管插管前及插管后HR、MAP、意识消失时间、插管时间及呛咳、躁动等插管反应发生率。结果3组麻醉诱导前，HR、MAP的比较差异无统计学意义（P〉0．05）；诱导之后各指标均降低，插管前及插管后均为c组最高，与A、B组的两两比较，差异均有统计学意义（P〈0．05），提示麻醉期间c组血流动力学波动最小。意识消失时间、插管时间均为c组最短，其中后者与A、B组差异的两两比较，差异均有统计学意义（P〈0．05），意识消失时间c组明显短于B组，但与A组的比较，差异无统计学意义（P〉0．05）。3组插管反应发生率的两两比较，差异均无统计学意义（P〉0．05）。结论七氟烷浓度逐渐递减吸入诱导在神经外科患者中的应用起始浓度足够，利于患者迅速入睡，之后维持在较低水平利于缩短插管时间及维持血流动力学的平稳，为理想的麻醉诱导方案。

Objective To observe the effect of different concentrations of sevoflurane inhalation induction on hemodynamics of pa- tients in neurosurgery department. Methods Ninety cases of surgical patients who were admitted into the neurosurgery department in the hospital during January 2013 to April 2015 were selected as the research objects. According to the random number table method, the objects were divided into A, B and C of three groups with 30 cases in each group. The concentration of sevoflurane inhaled by group A was 8% while by group B was 4%. Patients in group C firstly inhaled 8% sevoflurane and reduced to 2% every 2min till maintained at 4%. The HR, MAP, disappearing time of consciousness, time of intubation, incidence rates of bucking and dysphoria were compared among the three groups before induction, before and after intubation. Results Before induction, there was no statistical significance in the comparison of HR and MAP （P 〉 0.05）. Later, the indexes decreased, which were the highest in group C before and after intubation. The comparisons between two groups with group A and B were statistically significant （P 〈 0.05 ） , which indicated that the fluctuation of hemodynamics in group C during anesthesia was the lowest. The disappearing time of consciousness and intubation time of group C was the shortest, and the comparison of the latter with group A and B was statistically significant （ P 〈 0.05 ）. The disappearing time of consciousness in group C was significantly shorter than that in group B, but there was no statistical significance, compared with group A （P 〉 0. 05）. There was no statistical significance in the comparison of the incidence rate of intubation reaction between the two groups of the three groups （ P 〉 0.05）. Conclusion The initial concentration of sevoflurane inhalation induction with gradually decreasing concentration is sufficient, which is helpful for patients to go to sleep quickly. Then, maintaining at a relatively low level is good for shortening the time of intubation and maintain the stability of hemodynamics, which is the ideal plan of anesthesia induction.