七氟烷静吸复合与全凭静脉两种方法对肝脏部分切除术患者麻醉恢复质量的影响

Effects of inhalation and intravenous anesthesia with sevoflurane versus total intravenous anesthesia on recovery of patients undergoing partial hepatic resection

目的探讨七氟烷静吸复合麻醉与全凭静脉麻醉两种麻醉方法对肝脏部分切除术患者麻醉恢复质量的影响.方法ASA分级Ⅰ~Ⅱ级择期行肝脏部分切除术患者50例,随机等比分为静吸复合组(A组)与全凭静脉组(B组).麻醉诱导后维持:A组,七氟烷0.3~0.5 MAC持续吸入,丙泊酚靶控血药浓度1.5~3.0μg/ml泵注,瑞芬太尼靶控血药浓度2.0~8.0 ng/ml泵注;B组,丙泊酚靶控血药浓度3.0~6.0μg/ml泵注,瑞芬太尼靶控血药浓度2.0~8.0 ng/ml泵注.观察记录患者呼吸恢复时间、苏醒时间及拔管时间,拔管期间患者的呛咳情况,拔管后1 min(T1)、5 min(T2)、10 min(T3)、20 min(T4)、30 min(T5)、40 min(T6)患者的躁动评分,疼痛评分.结果A组呼吸恢复时间、苏醒时间、拔管时间均小于B组[(8.0±3.5)mim比(15.0±5.2)min、(13.0±4.8)min比(20.6±6.0)min、(14.7±5.1)mim比(22.4±7.1)min,P<0.05];B组呛咳发生率明显小于A组(60.0%比20.0%,P<0.05).结论七氟烷静吸复合全麻缩短了患者苏醒时间及拔管时间,全凭静脉麻醉可以明显减少患者拔管时呛咳反应发生.

Objective To investigate the effects of inhalation and intravenous anesthesia with sevoflurane versus total intravenous anesthesia on recovery of patients undergoing partial hepatic resection.Methods Fifty ASA I orⅡpatients undergoing partial hepatic resection were allocated randomly into two group A and group B.After induction,general anesthesia was maintained with sevoflurane(0.3~0.5 MAC),propofol(1.5~3.0μg/ml target plasma concentration)and remifentanil(2.0~8.0 ng/ml target plasma concentration)in group A and propofol(3.0~6.0μg/ml target plasma concentration),remifentanil(2.0~8.0 ng/ml target plasma concentration)in group B.The times for respiration recovery,awakening,and extubation,as well as bucking response,were recorded.The Sedation-Agitation Scale and pain score were also noted 1(T1),5(T2),10(T3),20(T4),30(T5),and 40 min(T6)after extubation.Results The times for respiration recovery,awakening,and extubation in group A were shorter than those in group B[(8.0±3.5)mim vs.(15.0±5.2)min,(13.0±4.8)min vs.(20.6±6.0)min,and(14.7±5.1)mim vs.(22.4±7.1)min;all P<0.05].The incidence of bucking response was higher in group A than in group B(60.0%vs.20.0%,P<0.05).Conclusion Inhalation and intravenous anesthesia with sevoflurane can decrease the times of respiration recovery,extubating,and awakening;and total intravenous anesthesia can lower the incidence of bucking response in patients with partial hepatic resection.