吸入不同浓度七氟醚患者全血游离六氟异丙醇浓度的比较：与苏醒期躁动的关系

Comparison of free hexafluoro-isopropanol concentrations in whole blood of patients inhaling different concentrations of sevoflurane： the relationship with emergence agitation

目的比较吸入不同浓度七氟醚患者全血游离六氟异丙醇（HFIP）浓度及其与苏醒期躁动的关系。方法拟行腹腔镜胃肠道手术患者40例，年龄18-64岁，ASA分级Ⅰ或Ⅱ级，性别不限，采用随机数字表法分为不同吸入浓度七氟醚组：0.86%组（S1组，n＝13）、1.71%组（S2组，n＝14）及2.57%组（S3组，n＝13），分别吸入相应浓度七氟醚，同时靶控输注瑞芬太尼（靶浓度4-6 ng/ml）及静脉输注丙泊酚（4-12 mg·kg^－1·h^－1）、顺式阿曲库铵0.1 mg·kg^－1·h^－1，七氟醚吸入3 h时停用。分别于吸入七氟醚30 min、1、2和3 h及停止吸入后1、3和5 h时采集中心静脉血样，采用注射器顶空二次平衡法测定全血游离HFIP浓度。记录自主呼吸恢复时间、按指令睁眼时间和拔除气管导管时间、气管拔管后4 h内躁动和中度疼痛发生情况。结果3组全血游离HFIP浓度于吸入1 h时达峰值，后逐渐降低，停止吸入后浓度持续降低（P〈0.05）。与S1组比较，S2组各时点全血游离HFIP浓度升高，S3组吸入期间、停止吸入后1 h全血游离HFIP浓度降低（P〈0.05）；与S2组比较，S3组各时点全血游离HFIP浓度降低（P〈0.05）。S3组自主呼吸恢复时间、按指令睁眼时间和拔除气管导管时间长于其余2组（P〈0.05）。3组躁动发生率及中度疼痛发生率比较差异无统计学意义（P〉0.05）。结论全血游离HFIP浓度随吸入七氟醚浓度的增大而升高，而吸入浓度到达2.57%时，游离HFIP生成明显受到抑制，全血游离HFIP浓度降低；游离HFIP与苏醒期躁动无明显关系。

Objective To compare the free hexafluoro-isopropanol （HFIP） concentrations in whole blood of patients inhaling different concentrations of sevoflurane and further evaluate the relationship with emergence agitation.Methods Forty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, scheduled for elective laparoscopic gastrointestinal surgery, were divided into 3 groups according to the inhaled conentration of sevoflurane using a random number table： 0.86% group （group S1, n=13）, 1.71% group （group S2, n=14） and 2.57% group （group S3, n=13）. In S1, S2 and S3 groups, the corresponding concentrations of sevoflurane were inhaled, remifentanil （target concentration 4-6 ng/ml） was given by target-controlled infusion, and propofol （4-12 mg·kg^-1·h^-1） and cisatracurium 0.1 mg·kg^-1·h^-1 were infused intravenously at the same time, and sevoflurane was inhaled for 3 h, and then inhalation was stopped.At 30 min and 1, 2 and 3 h of sevoflurane inhalation and 1, 3 and 5 h after stopping inhalation, central venous blood samples were collected for determination of free HFIP concentrations in whole blood by the method of two-stage headspace equilibration.The recovery time for spontaneous breathing, time for eye opening on verbal command, extubation time and development of agitation and moderate pain within 4 h after extubation were recorded.Results Free HFIP concentrations in whole blood peaked at 1 of inhalation, then gradually decreased, and the concentrations decreased continuously after stopping inhalation in the three groups （P〈0.05）. Compared with S1 group, free HFIP concentrations in whole blood were significantly increased at each time point in S2 group, and free HFIP concentrations in whole blood were decreased during inhalation and at 1 h after stopping inhalation in S3 group （P〈0.05）. Compared with S2 group, free HFIP concentrations in whole blood were significantly decreased at each time point in S3 group （P〈0.05）. The recovery time of spontaneous breathing, time for eye opening on verbal commands and extubation time were significantly longer in S3 group than in the other two groups （P〈0.05）. There was no significant difference in the incidence of agitation or moderate pain among the three groups （P〉0.05）.Conclusion Free HFIP concentrations in whole blood increase with the increase in inhaled sevoflurane concentrations, however, production of free HFIP is markedly inhibited when the inhaled concentration reaches 2.57%, and free HFIP concentrations in whole blood decrease; free HFIP had nothing to do with the emergence agitation in patients.