七氟烷或丙泊酚联合瑞芬太尼用于全身麻醉的效果比较

目的比较七氟烷复合瑞芬太尼与丙泊酚复合瑞芬太尼两种全身麻醉维持方式在甲状腺手术中的应用效果。方法择期行甲状腺手术的患者60例，随机分为S组和P组各30例。在同样经喉罩全身麻醉并在听觉诱发电位指数（AAI）监测指导下，麻醉维持P组采用靶控输注丙泊酚（靶浓度2．5～3．5mg／L）联合瑞芬太尼（靶浓度4．5-5．5μg/L）效应室靶控输注（TCI）；S组采用吸入七氟烷（2％-4％）联合瑞芬太尼（靶浓度2．5～4．0斗s／L）。记录入室后诱导前（T0）、麻醉诱导后插喉罩前（T1）、插入喉罩时（T2）、切皮时（L3）、游离甲状腺时（T4）、切除甲状腺或肿物时（L5）、拔除喉罩时（T6）和出手术室时（L7）等8个时段的HR、SBP、DBP，停止麻醉至拔除喉罩的时间、拔除喉罩时的清醒程度和术后并发症情况。结果两组HR、SBP、DBP比较，T0、T1、T2、L3等四个时点的差异均无统计学意义（均P〉0，05）；T4、L5、T6、L7等四个时点的差异均有统计学意义（均P〈0．05）。两组问拔除喉罩时间及拔喉罩时清醒程度差异均无统计学意义（均P〉0．05）。术后并发症方面比较，S组苏醒期躁动、头晕嗜睡、寒战和出室时伤口疼痛的发生率较低（均P〈0．05），两组均未发生恶心呕吐。结论七氟烷复合瑞芬太尼麻醉方式更佳，术中血流动力学更稳定，术后并发症发生率更低。

Comparison of efficacy of sevoflurane or propofol combined with remifentanil in the maintenance of general anesthesia

Objective To explore the efficacy of sevoflurane or propofol combined with remifentanil during the maintenance of general anesthesia in thyroid gland surgery.Methods Sixty patients underwent thyroid gland surgery were randomly divided into tow groups.Once the larynx mask was intubated, anesthesia was maintained with propofol(the effect site concentration was 2.5 ～3.5mg/L) and remifentanil(the effect site concentration was 4.5 ～5.5μg/L) by TCI technique in group P,but with sevoflurane(2％～4％) and remfentanil(the effect site concentration was 2.5 ～4.0g/L)in group S.The depth of anesthesia was measured by the A-line TM AEP Monitor which expressed as A-Line ARX Index TM(AAI).All patients' SBP,DBP and HR were recorded at eight time points: before induction time(T0) ,after induction but before larynx mask intubation time(T1) ,intubate larynx mask time(T2) ,cut skin time (T3), separate thyroid gland time (T4), cut thyroid gland time (T5), remove larynx mask time (T6) ,leave the operation room time(T7).The emergency time,the conscious of the patients after anesthesia and the side effects were also recorded.Results There were no significant differences between the groups with respect to age,gender,weight,the duration of operation,the emergency time and the conscious of the patients after anesthesia.SBP,DBP,HR of the patients in both groups showed no significant difference at T0,T1 ,T2, T3 (all P ＞ 0.05), but had significant difference at T4,T5,T6, T7 (all P ＜ 0.05).Compare with group P,the incidentce of restlessness, dizziness, drowsiness, rigor and pain was significantly lower in group S(all P ＜0.05).The incidentce of nausea,vomit and aspiration did not appear in both groups.Conclusion Both groups showed good anesthesia effects and the patients also emerged from anesthesia quickly.But the anesthesia maintained with sevoflurane and remifentanil could bring more stable hemodynamics and lower incidence rate of the side effects.