丙泊酚-七氟醚静吸复合麻醉停药顺序对成人经腹胆囊切除术患者苏醒质量的影响

Nfluences of Drug Withdrawal Sequence in Propofol-Sevoflurane Inhalation Anesthesia on Recovery Quality of Adult Patients with Abdominal Cholecystectomy

目的:比较丙泊酚-七氟醚静吸复合麻醉不同的停药顺序对成人经腹胆囊切除手术全身麻醉后苏醒时间、苏醒期血流动力学的影响。方法:选择择期行经腹胆囊切除术加胆总管切开取石术的患者40例,麻醉诱导均采用咪达唑仑,瑞芬太尼,丙泊酚,维库溴铵;维持均采用丙泊酚血浆浓度在2~3 mg/L、瑞芬太尼的血浆浓度在3~5μg/L持续泵入,七氟醚0.7~1肺泡最小有效浓度(MAC)持续吸入;根据停药顺序分为先停丙泊酚组(A组)和先停七氟醚组(B组),观察入室后(T0)、拔除气管导管时(T1)、拔除气管导管后5 min(T2)、拔除气管导管后10 min(T3)时的平均动脉压(MAP)和心率(HR),同时观察自主呼吸恢复时间、清醒时间、拔除气管导管时间以及苏醒期躁动、呼吸抑制、术后恶心呕吐等不良反应的发生情况。结果:两组患者各时点平均动脉压、心率比较差异无统计学意义(P>0.05),A组患者自主呼吸恢复时间、清醒时间、拔除气管导管时间均较B组短,但两组比较差异无统计学意义(P>0.05);两组不良反应发生情况相似。结论:丙泊酚-七氟醚静吸复合麻醉用于成人经腹胆囊切除加胆总管切开取石术时,两种停药顺序对麻醉后苏醒时间及苏醒期血流动力学指标无明显影响。

Objective： To observe the influence of drug withdrawal sequence in propofol-sevoflurane inhalation anesthesia on the awakening time and hemodynamics of patients with abdominal cholecystectomy in the recovery period. Methods： Forty patients whose anesthesia induction adopted by midazolam,remifentanil,propofol and vecuronium underwent the elective abdominal cholecystectomy and choledocholithotomy. Anesthesia maintenance used the plasma target-controlled infusion of propofol and remifentanil with propofol plasma concentration of 2-3 mg/L,continuous pumping of 3-5 μg/L remifentanil plasma concentration,and continuous inhalation of sevoflurane in 0. 7-1 MAC. Patients were divided into the first group of propofol（ group A） and first group of sevoflurane（ group B） according to the sequence of drug withdrawal,so the hemodynamic indexes,the time of recovery and theincidence of adverse reactions were observed in the observation room. Results： The values of MAP and HR were compared between the two groups. However,there was no significant difference in the values of MAP and HR between the two groups at each time point（ P〈0. 05）. Compared with the recovery time of group B spontaneous breathing,awake time and extubation time,there is a clear trend of lengthening time than group A,but the difference between two groups was not statistically significant（ P〈0. 05）. The incidence of adverse reactions was similar. Conclusion： Propofol-sevoflurane inhalation anesthesia is adopted for the adult patients of abdominal cholecystectomy and choledocholithotomy,there is no difference in the recovery time and hemodynamic index of the two drug withdrawal orders.