TCI与异氟醚吸入全麻在鼻内镜手术中的比较

目的观察静脉靶控输注（TCI）瑞芬太尼-丙泊酚麻醉和吸入异氟醚两种不同麻醉方式对鼻内镜手术血流动力学和术后恢复的影响及成本差异。方法择期行鼻内镜手术患者80例,ASAⅠ～Ⅱ级,随机分为两组,每组40例。静脉靶控输注组（TCI组）以瑞芬太尼血浆靶浓度3～4ng/ml、丙泊酚血浆靶浓度4～6μg/ml靶控输注;异氟醚吸入组（Iso组）以异氟醚0.7～1.3MAC吸入。记录围术期血流动力学参数及术后恢复情况。记录麻醉时间及瑞芬太尼、丙泊酚用量,异氟醚吸入浓度及维持时间,计算单位时间瑞芬太尼、丙泊酚及异氟醚的用量及费用。结果 TCI组术后睁眼时间（99.14±28.70）secvs.（909.15±384.57）sec]、呼吸恢复时间（84.20±33.71）secvs.（616.50±252.97）sec]和拔管时间（98.36±37.53）secvs.（707.25±292.86）sec]均明显短于Iso组（P均﹤0.01）,清醒评分显著高于Iso组（4.00±0.00vs.2.1±1.41,P=0.000）。TCI组单位时间麻药费用高于Iso组（2.62±0.42）理论值元/minvs.（1.26±0.26）理论值元/min,P=0.007]。结论鼻内镜手术应用静脉靶控输注丙泊酚-瑞芬太尼或异氟醚吸入麻醉,均可达到术中满意的麻醉效果。静脉靶控输注丙泊酚-瑞芬太尼单位时间麻醉药物消耗费用略高,但苏醒更迅速完全。

The comparison of TCI and Isoflurane inhalation anesthesia in patients undergoing sinus endoscopic surgery

Objective To compare the effects and the consumptions between target controlled infusion of propofol and remifentanil with Isoflurane inhalation anesthesia in patients undergoing nasal-endoscopic surgery.Methods Eighty ASA I～Ⅱ patients undergoing nasal-endoscopic surgery were randomly divided into two groups（n=40）.TCI Group：the target concentration of remifentanil was 3～4ng/ml,propofol 4～6μg/ml.The Iso Group：Isoflurane inhalation 0.7～1.3MAC.Hemodynamic parameters and BIS were measured during the operation.The recovery time and the anesthetics consumption were recorded.Results The recovery time in the TCI Group was significantly shorter than that in the Iso Group.The awareness scores in the TCI Group were markedly higher than in the Iso Group.The consumption of anesthetics per minute in the TCI Group was higher than in the Iso Group.Conclusions TCI can improve the recovery of patients compared with inhalation Isoflurane anesthesia.However TCI increases the consumption of anesthetics per minute.