Zeus麻醉机七氟烷低流量麻醉、全紧闭麻醉与双频指数监测下的全紧闭麻醉的比较

Comparison of three anaesthetic techniques of low-flow、closed circuit and closed circuit with BIS monitoring for Zeus anesthesia machine and Sevoflurane anesthesia

目的探讨Zeus麻醉机七氟烷的应用方法。方法45例ASAⅠ-Ⅱ级拟在全身麻醉下行甲状腺大部切除手术或者乳腺肿物切除术患者随机分为3组，A组（LFA）：低流量麻醉，新鲜气流量1L／min，氧浓度50％；B组（CCA）：循环紧闭麻醉，氧浓度50％；C组（CCA＋BIS）：脑电双频指数监测下循环紧闭麻醉，氧浓度50％，每组15例。A、B组根据临床麻醉体征（BP、HR）和手术刺激情况调整呼气末七氟烷目标刻度，C组使BIS值恒定于46±10，根据BP、HR、BIS值调整目标MAC值。分别于入室后（T0）、切皮前（T1）、插管后5min（T2）、处理腺体时（T3）、缝皮时（T4）、手术结束时（T5）观察并记录3组患者的平均动脉压（MAP）、心率（HR），术后记录舒芬太尼、顺式阿曲库胺、七氟烷的使用量、麻醉总时间，手术开始后10min、20min、30min、40min、50min、60min时的呼气末七氟烷维持浓度，记录从停止吸入七氟烷至呼吸恢复及意识恢复的时间。结果A组、B组、C组的平均动脉压及心率无显著差异（P〉0．05）；术中顺式阿曲库胺、舒芬太尼使用量及麻醉总时间无显著差异（P〉0．05）；三组呼气末七氟烷维持浓度A组〉B组、A组〉C组（P〈0．01）；呼吸恢复时间和意识恢复时间，A组〈B组〈C组（P〈0．05）。结论Zeus麻醉机全紧闭麻醉联合双频指数监测可节省七氟烷用量，缩短呼吸恢复和意识恢复时间，是一种较理想的麻醉方法。

Objective To explore the application method of the Zeus anesthesia with sevoflurane. Methods Forty-five cases of ASA Ⅰ-Ⅱ class intending to surgery to remove breast tumor resection in patients with thyroid most of the general anesthesia were randomly divided into three groups： group A （LFA） ： low flow anesthesia, 1.0 L/min fresh-phase flow, 50% of the oxygen concentration; group B （CCA） ： closed circuit anesthesia, 50% of the oxygen concentration; group C （CCA ＋ BIS） ： Closed circuit anesthesia-bispectral index monitoring anesthesia, 50% of the oxygen concentration, n = 15 cases. The sevoflurane vaporizer was adjusted according to the signs （BP, HR）, clinical anesthesia and surgical stimulation in group A and B. In group C, the BIS value was made constant at 46 ± 10, and the target MAC Value was adjusted according to the BP, HR and the BIS value. The mean arterial pressure （MAP）, heart rate （HR） in the time of after entering the operating room（ T0 ）, before skin incision （T1）, 5 minutes after intubation （T2）, the handling of the gland （T3 ）, skin closure （ T4 ）, the ending of surgery （ T5 ） in the three group patients were respectively observed and recorded. After the operation the usage amount of sufentani, ciatracurium and sevoflurane and total time of anesthesia in three groups were respectively recorded. The end-tidal sevoflurane concentration in time of 10 minutes after the start of surgery, 20 minutes, 30 minutes, 40 minutes, 50 minutes, 60 minutes after the start of the operation were recorded, the time from stop inhaling sevoflurane to the breathing and consciousness recovery was recorded. Results The mean arterial pressure and heart rate of group A, group B, group C had no signficant difference （P 〉 0. 05） ; The usage amount of sufentani, ciatracurium and sevoflurane and total time of anesthesia in three groups had no signficant difference （P 〉 0. 05 ） ; At the end of expiratory sevoflutane maintain concentration in the three groups, group A was more than group B, group A was more than group C （P 〈 0.01 ）. Breath recovery time and consciousness recovery time of group C were less than group A and group B （P 〈 0. 01 ）. Conclusion It＇ s an ideal anesthesia method for Zeus anesthesia machine combined with bispectral index monitoring to reduce the dosage of sevoflurane and shorten the breath recovery time and consciousness recovery time.