七氟烷复合瑞芬太尼靶控用于老年人的麻醉

目的观察七氟烷复合瑞芬太尼靶控麻醉在老年人的麻醉效果。方法择期手术老年患者30例,ASAI或Ⅱ级,年龄65～75岁,随机分为七氟烷（S组,n=15）和异氟烷（I组,n=15）两组。均同时复合TCI（TCI-I型泵Minto药代动力学参数）瑞芬太尼,血浆靶浓度2ng/ml静脉输注维持。术中记录两组基础值（T0）、气腹时（T1）、手术切皮时（T2）、气腹后5min（T3）、气腹结束时（T4）、手术结束时（T5）、拔管即刻（T6）、拔管后5min（T7）的收缩压（SBp）、舒张压（DBp）、心率（HR）,从停止TCI开始分别记录自主呼吸恢复时间、呼之睁眼时间、拔管时间。结果 S组苏醒时间、拔管时间显著短于I组,组间比较P〈0.05,差异具有统计学意义。结论两组均可提供满意的麻醉效果,但是与I组比较,S组麻醉可控性更佳,可明显加速苏醒时间和拔管时间。

Anaesthesia for Elderly Patients:a Randomized Blind Comparison of Sevoflurane-Remifentanil or Isoflurane-Remifentanil

Objective To compare the effects of anesthesia with remifentanil given by target-controlled infusion（TCI）between sevoflurane and isoflurane on elderly patients.Methods Thirty ASA I or Ⅱ patients undergoing elective operation were studied after written informed consent.The patients were divided into 2 groups according to sevoflurane and isoflurane：group I（sevoflurane）and group Ⅱ（isoflurane）.Anesthesia was induced with the target 3.0 ng/ml plasma concentration of remfentanil.After tracheal intubation and before skin incision the target plasma concentration of remifentanil were reduced to 2.0 ng/ml.Anaesthesia was maintained with end-tidal concentrations 1.0MAC and remifentanil.Arterial pressure,heart rate,BIS values were recorded.Hemodynamic variables,spontaneous recovery time,open eye time and extubation time were assessed.Results Hemodynamic variables was similar in the two groups.Spontaneous recovery time,open eye time and extubation time occurred earlier after sevoflurane （5.12±1.32）min,（7.13±1.45）min and（9.36±2.12）min] than isoflurane（9.31±1.15）min,（12.21±2.32）min and（13.16±2.43）min]（P=0.003,0.005 and,0.04 respectively）.Conclusion Both the sevoflurane-remifentanil and isoflurane-remifentanil combinations provided a similarly adequate intraoperative cardiovascular stability.Spontaneous recovery time,open eye time and extubation time were faster with sevoflurane-remifentanil than with isoflurane-remifentanil,differences were present between the two agents.