七氟烷或丙泊酚联合瑞芬太尼用于腹腔镜手术麻醉的比较

目的比较七氟烷、瑞芬太尼静吸复合麻醉与丙泊酚、瑞芬太尼靶控输注（TCI）全凭静脉麻醉,为临床合理应用提供参考。方法52例择期妇科腹腔镜手术病例,随机均分为S、P 2组。自诱导至术毕2组始终以5 ng／mL效应室TCI输注瑞芬太尼,S组在以丙泊酚、琥珀胆碱完成插管后改吸七氟烷,P组以TCI输注丙泊酚。术中维持听觉诱发电位指数（AAI）在15-25。观察各时点血流动力学参数、血糖变化,记录苏醒及拔管时间、拔管后镇静评分（OAAS）、术后认知功能评分（MMSE）以及术中高血压、低血压、心动过缓和术后不良反应发生情况。结果术中各时点AAI及血流动力学参数变化两组无明显差异,术毕前及拔管后10min两组血糖均有所升高,与基础值比差异有显著性（P〈0．05）,但均在正常范围且两组间无明显差异。苏醒时间P组明显长于S组（11．2 vs 7．0min）（P〈0．05）,苏醒后无论是OAAS评分还是MMSE评分两组间均无明显差异,术后认知功能均较术前有短暂下降,但术后2 h已基本恢复。术中、术后不良事件发生率以及术后24 h内VAS评分两组间差异均无显著性。结论七氟烷或丙泊酚联合瑞芬太尼用于妇科腹腔镜手术都能提供满意的麻醉,副反应相似,七氟烷比丙泊酚可控性更佳,术后苏醒更为迅速。

Comparison of sevoflurane/remifentanil and propofol/remifentanil anesthesia in patients undergoing gynecological laparoscopic surgery

Purpose To compare clinical properties of sevoflurane /remifentanil with propofol / remifentanil anesthesia in patients undergoing gynecological laparoscopic surgery, which included maintenance of anesthesia, postoperative recovery, and cognitive functions. Methods Fifty-two patients were randomized to either total intravenous anesthesia (group P) or sevoflurane anesthesia (group S). All patients received a target-controlled effect-compartment concentration of 5 ng/mL remifentanil from induction of anesthesia to the endpoint of surgery. Anesthesia was maintained with sevoflurane after tracheal intubation with propofol and scoline in group S, and maintained with propofol target-controlled infusion in group P. AAI values were kept between 15-25 intraoperatively. Hemodynamic parameters were observed continuously. Blood glucose were measured before induction, before the end of surgery and 10 min after extubation. Recovery time, extubation time, sedation scores(OAAS) , cognitive functions (MMSE), incidence of hypotensive or hypertensive episodes, PONV and pain scores (VAS) were also analyzed. Results The changes of AAI and hemodynamic parameters were comparable between the two groups. Blood glucose increased significantly before the end of surgery and 10 min after extubation, compared with the baseline levels in both groups(P <0. 05), but all values were within normal range and comparable in the two groups. Recovery time was significantly shorter in group S than in group P (7. 0 versus 11.2 min) (P <0. 05). There was no difference not only in sedation scores but also in MMSE scores between the two groups before and after surgery. The MMSE scores decreased significantly only 1 h after surgery, compared with those before surgery in both groups,and returned to preoperative levels within 2 h after surgery. Incidence of PONV or other side effects and VAS scores within 24 h postoperatively were also not different between groups. Conclusions Sevoflurane /remifentanil and Propofol /remifentanil both provide satisfactory anesthesia for gynecological laparoscopic surgery, and the side effects are similar between these two techniques except that sevoflurane is associated with more rapid early recovery than propofol.