七氟醚联合丙泊酚麻醉维持在全麻复合硬膜外麻醉中的临床应用

Application of sevoflurane combined with propofol anesthesia maintenance in general anesthesia combined with epidural anesthesia

目的：比较丙泊酚联合七氟醚用于全身麻醉维持与七氟醚单独用于麻醉维持对于患者苏醒的影响。方法：随机将160例择期在硬膜外阻滞复合全身麻醉下行胃肠手术的患者分为七氟醚组（S组,n=80）和七氟醚/丙泊酚组（SP组,n=80）。麻醉诱导后,S组采用七氟醚维持麻醉,SP组采用七氟醚联合丙泊酚（1.2μg/mL）维持麻醉。麻醉维持期间维持脑电双频指数（BIS）在40~60。记录拔管时间、苏醒期间严重呛咳和躁动以及其他相关事件的发生率。结果：SP组苏醒和拔管时间分别为（7.2±2.0）min和（8.0±1.8）min,S组苏醒和拔管时间分别为（12.3±1.5）min和（12.8±1.6）min,差异有统计学意义（P〈0.05）。SP组严重呛咳和躁动的发生率分别为30%和25%,S组严重呛咳和躁动的发生率分别为68%和53%,差异有统计学意义（P〈0.05）。两组患者拔管时BIS值、麻醉期间芬太尼和肌松药用量差异无统计学意义。结论：与七氟醚维持相比,七氟醚联合丙泊酚用于麻醉维持,患者麻醉苏醒更快,且苏醒期呛咳和躁动的发生率较低。

Objective：To compare the effects of propofol combined with sevoflurane on maintenance of general anesthesia with sevoflurane alone for maintenance of anesthesia for patients＇ recovery.Methods：160patients scheduled for gastrointestinal surgery under epidural block combined with general anesthesia were randomly divided into sevoflurane group（group S,n=80）and sevoflurane/propofol group（group SP,n=80）.After induction,anesthesia was maintained with sevoflurane in group S and sevoflurane combined with propofol（1.2μg/mL）in group SP.Bispectral Index（BIS）values were maintained at 40-60 during the maintenance of anesthesia.The time to extubation,the incidence of serious cough and agitation during emergence,and other related events were recorded.Results：The recovery time and the time to extubation in the SP group were（7.2±2.0）min and（8.0±1.8）min,respectively,the recovery time and the time to extubation of the S group were（12.3±1.5）min and（12.8±1.6）min,and the difference was statistically significant（P〈0.05）.The incidence of serious coughing and agitation in SP group（30%and 25%）were significantly lower than that of group S（68% and 53%,P〈0.05）.There was no significant difference in BIS value,the dosage of fentanyl and muscle relaxants during anesthesia between the two groups.Conclusions：Compared with sevoflurane maintenance,sevoflurane combined with propofol for anesthesia maintenance shortens the recovery time and leads to lower incidence of emergence coughing and agitation.