七氟烷与地氟烷对腹腔镜胆囊切除术中手术体积描记指数的影响

Effects of sevoflurane and desflurane on surgical pleth index in laparoscopic cholecystectomy

目的:探讨相同最低肺泡有效浓度(MAC)的七氟烷和地氟烷对腹腔镜胆囊切除术中手术体积描记指数(SPI)的影响。方法:选择90例择期行腹腔镜胆囊切除术病人,随机将病人分为七氟烷组(S组)和地氟烷组(D组),各45例。S组采用丙泊酚效应室浓度3μg/mL+瑞芬太尼效应室浓度3 ng/mL静脉泵入、七氟烷吸入以及罗库溴铵0.6 mg/kg静脉推注进行麻醉诱导;D组采用丙泊酚效应室浓度3μg/mL+瑞芬太尼效应室浓度3 ng/mL静脉泵入、地氟烷吸入以及罗库溴铵0.6 mg/kg静脉推注进行麻醉诱导。麻醉维持采用1.0 MAC七氟烷或地氟烷持续吸入联合瑞芬太尼效应室浓度3 ng/mL静脉泵入,监测麻醉镇静深度和镇痛深度。比较2组麻醉诱导前和气腹期间的心率、平均动脉压(MAP)、脑电双频指数(BIS)和SPI。结果:麻醉诱导前,2组BIS、SPI、心率、MAP差异均无统计学意义(P>0.05);气腹期间,D组SPI、BIS、MAP均低于七氟烷组(P<0.05)。结论:在腹腔镜胆囊切除术中,相同MAC的地氟烷较七氟烷可产生更低的SPI值,提示地氟烷可以产生更深的镇静水平。

Objective:To explore the effect of sevoflurane and desflurane with the same minimum alveolar concentration(MAC)on the surgical pleth index(SPI)during laparoscopic cholecystectomy.Methods:A total of 90 patients scheduled for laparoscopic cholecystectomy were admitted,and randomly divided into sevoflurane(group S)and desflurane group(group D),with 45 patients in each group.Group S was induced by intravenous infusion of propofol effect chamber concentration of 3μg/mL+remifentanil effect chamber concentration of 3 ng/mL,inhalation of sevoflurane and intravenous injection of 0.6 mg/kg rocuronium.Group D was induced by intravenous infusion of propofol effect chamber concentration of 3μg/mL+remifentanil effect chamber concentration of 3 ng/mL,inhalation of desflurane and intravenous injection of 0.6 mg/kg rocuronium.Anesthesia maintenance was performed by continuous inhalation of 1.0 MAC sevoflurane or desflurane,combined with intravenous infusion of remifentanil at an effect chamber concentration of 3 ng/mL.The depth of anesthesia sedation and analgesia was monitored.Heart rate(HR),mean arterial pressure(MAP),bispectral index(BIS)and SPI before anesthesia induction and during pneumoperitoneum were compared between the two groups.Results:Before anesthesia induction,there was no statistically significant difference in BIS,SPI,HR,and MAP between the two groups(P>0.05).During pneumoperitoneum,the SPI,BIS,and MAP in the group D were significantly lower than those in the group S(P<0.05).Conclusions:In laparoscopic cholecystectomy,desflurane with the same MAC can produce lower SPI values compared to sevoflurane,suggesting that desflurane can produce deeper levels of analgesia.