氯胺酮与喉罩-七氟醚全麻在小儿斜疝手术中应用的对比研究

目的:比较氯胺酮与喉罩-七氟醚两种麻醉方法在小儿斜疝手术中应用的优缺点.方法:40例ASA Ⅰ～Ⅱ级,2～5岁择期斜疝手术患儿,随机分为静脉氯胺酮全麻(K)组与喉罩-七氟醚麻醉(S)组,每组20例.观察患儿术中生命体征、苏醒时间、PACU停留时间、围术期并发症.结果:麻醉前两组患儿血压及心率无统计学差异,麻醉后K组各个时点血压及心率明显高于麻醉前及对应时间点的S组患儿(P＜0.01).K组麻醉苏醒时间、PACU停留时间明显长于S组(P＜0.01).K组患儿肢体活动和SpO2＜95%发生率明显高于S组(P＜0.05).结论:与氯胺酮静脉全麻相比,喉罩-七氟醚全麻用于小儿斜疝手术具有对全身影响小、麻醉平稳、苏醒快、不良反应发生率低等优点.     

七氟醚喉罩吸入复合骶麻在小儿斜疝手术中的应用

ASAI-Ⅱ级,年龄2~5岁的择期行斜疝高位结扎手术患儿70例。随机分为A、B两组。A组七氟醚吸入下开放静脉,置入喉罩后行骶丛阻滞。 B组先开放静脉,给氯胺酮1.5~2mg/kg iv后行骶丛阻滞,观察患儿术中生命体征,苏醒时间,围手术期并发症。结果七氟醚喉带吸入组（A）组与氯胺酮静脉全麻组（B组）患儿年龄、体重、手术时间等方面比较无统计学意义（P＞0.05）,氯胺酮静脉全麻组有17例SPO2下降、5例呼吸道分泌物增多,1例发生呛咳,在七氟醚喉罩吸入组无呼吸抑制情况发生。七氟醚喉罩吸入复合骶麻的方法可安全用于小儿斜疝高位结扎手术的。     

新型长效酰胺类局部麻醉药用于小儿腹股沟斜疝手术的临床观察

目的：探讨七氟醚全麻复合左布比卡因髂腹下神经阻滞用于小儿腹股沟斜疝的可行性和安全性。方法：小儿腹股沟斜疝手术60例,A SAⅠ-Ⅱ级,随机分为两组,每组30例。Ⅰ组患儿入室后予面罩直接吸入5%七氟醚加纯氧（4 L/m in）,待患儿睫毛反射消失、全身松弛后置入喉罩通气,然后用0.25%左旋布比卡因0.5-0.7 m g/kg行患侧髂腹下神经阻滞,术中吸入2%-2.5%七氟醚。Ⅱ组患儿入室后麻醉诱导时吸入七氟醚浓度同Ⅰ组,术中根据需要调整七氟醚吸入浓度。记录麻醉后切皮时、分离疝囊时、术毕时各时点的心率（HR）、平均动脉压（M AP）;术后麻醉苏醒时间以及术后哭闹、躁动情况;术后疼痛评分。结果：Ⅱ组患儿监测各时点HR,M AP明显高于Ⅰ组（P〈0.05）。术后苏醒期躁动亦显著增加,苏醒时间明显延长（P〈0.05）。术后疼痛评分Ⅱ组明显高于Ⅰ组（P〈0.05）。结论：七氟醚全麻复合左旋布比卡因髂腹下神经阻滞用于小儿腹股沟斜疝修补术麻醉安全、有效。     

喉罩七氟醚吸入麻醉对腹股沟斜疝患儿术中应激反应及术后苏醒的影响

目的:观察喉罩七氟醚吸入麻醉对腹股沟斜疝患儿术中应激反应及术后苏醒的影响。方法:选取我院2016年4月～2018年1月腹股沟斜疝患儿53例,依据麻醉方式不同分组,对照组26例采取氯胺酮与异丙酚联合麻醉,研究组27例采取喉罩七氟醚吸入麻醉,比较2组术前、切皮时、手术1 h时、拔管时肾上腺素(E)、皮质醇(Cor)、内皮素(ET)水平及术后苏醒时间。结果:2组术前ET、Cor、E水平差异不明显(P0.05);研究组切皮时、手术1 h时、拔管时ET水平较对照组低,手术1 h时、拔管时Cor、E水平较对照组低(P0.05);研究组术后苏醒时间较对照组短(P0.05)。结论:对腹股沟斜疝患儿采取喉罩七氟醚吸入麻醉,能减轻术中应激反应及缩短术后苏醒时间。     

七氟醚吸入麻醉复合单次骶管阻滞在小儿腹股沟斜疝手术中的应用

目的探讨七氟醚吸入麻醉复合单次骶管阻滞在小儿腹股沟斜疝手术中的应用效果。方法将40例择期行腹股沟斜疝疝囊高位结扎术的患儿按随机数字表法分为A﹑B组,每组20例。A组行七氟醚吸入麻醉复合单次骶管阻滞麻醉;B组行氯胺酮肌内注射基础麻醉加氯胺酮、丙泊酚静脉麻醉。观察2组患儿术中平均动脉压（MAP）、HR的变化及麻醉苏醒时间与不良反应发生情况。结果 2组麻醉效果均能满足手术要求。A组骶管穿刺均为一次成功,阻滞平面固定于T8～T10以下,无一例发生全脊麻或局麻药中毒。2组MAP均有波动,但波动值2组相比差异无统计学意义（P〉0.05）,A组HR波动值显著小于B组（P〈0.05）;A组麻醉苏醒时间明显短于B组（P〈0.05）,不良反应发生率明显少于B组（P〈0.05）。结论七氟醚吸入麻醉复合单次骶管阻滞是小儿腹股沟斜疝手术一种较为理想的麻醉方法,提高了小儿腹股沟斜疝围手术期的安全性、有效性。     

神经阻滞在七氟醚全身麻醉患儿的应用价值

目的:观察髂腹股沟神经-髂腹下神经联合阻滞预防七氟醚全身麻醉下行腹股沟斜疝疝囊高危结扎术患儿苏醒期躁动及术后镇痛的效果。方法:60例择期行腹股沟斜疝疝囊高位结扎术患儿随机分为2组,每组30例,Ⅰ组给予髂腹股沟神经-髂腹下神经联合阻滞+七氟醚吸入全身麻醉,Ⅱ组给予七氟醚吸入全身麻醉。观察2组苏醒期躁动发生率及术后24 h镇痛满意率。结果:Ⅰ组发生苏醒期躁动2例(6.7%)且较轻微,镇痛满意率93.33%,无严重疼痛患儿;Ⅱ组发生苏醒期躁动13例(43.3%),镇痛满意率为0,5例严重疼痛患儿,2组比较差异有统计学意义(P<0.05)。结论:髂腹股沟-髂腹下神经联合阻滞可明显降低七氟醚全身麻醉苏醒期躁动的发生率,且术后24 h镇痛效果满意。     

非插管下七氟烷吸入辅以局部麻醉用于小儿斜疝手术的效果

目的 探讨非插管下吸入七氟烷并辅助局部麻醉用于小儿腹股沟斜疝手术的可行性和安全性.方法 将80例ASA Ⅰ级择期行斜疝手术的患儿按随机数字表法分为2组:K组40例采用氯氨酮辅助局部麻醉,S组40例采用七氟烷辅助局部麻醉.比较2组的诱导时间、苏醒时间及苏醒期躁动发生情况.结果 S组的诱导时间和苏醒时间均明显短于K组,差异具有统计学意义(P＜0.01),苏醒期躁动发生率S组高于K组,差异具有统计学意义(P＜0.01).2组术中均未发生呛咳、喉痉挛、流涎等不良反应.结论 七氟烷用于小儿斜疝手术的麻醉诱导及苏醒时间均较氯氨酮麻醉短,而在非插管情况下,七氟烷吸入辅以局部麻醉用于小儿斜疝手术更安全.     

七氟醚复合氯胺酮静脉麻醉在小儿斜疝手术中的应用

目的观察七氟醚复合氯胺酮静脉麻醉在小儿斜疝修补手术中应用的安全性、可行性及优点。方法选择择期行斜疝修补手术的小儿患者80例,随机分成两组,A组采用七氟醚复合氯胺酮静脉麻醉,B组采用氯胺酮加咪达唑仑静脉麻醉。麻醉过程中监测呼吸循环相关参数,记录麻醉效果,不良反应,术后苏醒时间及氯胺酮用量。结果A组的氯胺酮用量明显少于B组（P〈0．05）,术后苏醒时间,明显短于B组（P〈0．05）,B组切皮时心率、平均动脉压上升较A组显著（P〈0．05）,术后躁动等不良反应多于A组（P〈0．05）。结论七氟醚复合氯胺酮静脉麻醉用于小儿斜疝修补手术比氯胺酮加味达唑仑麻醉曼平稳．苏醒更快．不良反应更少．     

七氟醚面罩吸入复合阴茎根部神经阻滞在小儿包皮环切术中的应用

目的 探讨七氟醚面罩吸入复合阴茎根部神经阻滞在小儿包皮环切术中的临床效果.方法 选择60例择期行小儿包皮环切术的患儿,按随机数字表法分为七氟醚面罩吸入复合阴茎根部神经阻滞组(A组)和丙泊酚、氯胺酮静脉麻醉组(B组),每组30例.记录2组患儿睫毛反射消失时间,观察2组患儿诱导前、诱导后、切皮后1 min及清醒时的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)及术中肢体活动例数、清醒时间、清醒后躁动例数.结果 A组和B组诱导后睫毛反射消失时间差异无统计学意义(P＞0.05);A组在诱导前后和术中的SBP、DBP、HR、SpO2无明显波动(均P＞0.05),A组术中肢体活动例数、清醒时间、清醒后躁动例数明显少于B组(均P＜0.05);2组均未出现喉痉挛和气道梗阻等并发症.结论 七氟醚面罩吸入复合阴茎根部神经阻滞在小儿包皮环切术中能维持生命体征平稳,术后清醒快而完全,躁动发生率低.     

七氟醚吸入复合骶管阻滞在小儿下腹部的应用

目的:探讨七氟醚吸入复合骶管阻滞在小儿下腹部手术中的应用效果。方法:纳入2015年5月～2018年1月接受下腹部手术治疗的40例患儿,随机分为对照组和观察组各20例。对照组手术采用喉罩静吸麻醉,观察组手术采用七氟醚吸入复合骶管阻滞麻醉,比较两组不同时间点平均动脉压、心率水平,复苏时间,术后躁动、术后并发症发生情况。结果:观察组切皮时、术毕平均动脉压、心率水平低于对照组,差异有统计学意义(P<0.05);观察组复苏时间短于对照组,术后躁动、并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:小儿下腹部手术采用七氟醚吸入复合骶管阻滞麻醉效果良好,可将患儿术中、术毕平均动脉压、心率维持在较理想水平,缩短患儿复苏时间,减少患儿术后躁动、并发症发生率。     

熵和脑电双频指数指导成人七氟醚吸入联合少量丙泊酚的全麻诱导

目的：观察熵和脑电双频指数（BIS）指导成人七氟醚吸入诱导联合少量丙泊酚时的数量化脑电参数和血液动力学的变化、病人反应，探讨熵和BIS监测麻醉深度的可行性。方法：50例ASAⅠ～Ⅱ级择期手术患者．监测血压（BP）、心率（HR）、心电图（ECG）、脉搏氧饱和度（SpO2），记录安静时的反应熵（RE）、状态熵（SE）和BIS值。静脉推注丙泊酚0.8mg／kg，面罩吸氧（8L／min），2min后手控气囊吸入8％七氟醚，进行气管插管。记录静息下（t0）、静注丙泊酚后2min（t1）、插管前即刻（t2）、插管后1min（t3）、插管后3min（t4）的RE、SE、BIS、平均动脉压（MAP）、HR.记录麻醉诱导开始至气管插管完成时间，观察诱导插管过程中病人的反应。结果：熵和BIS在各不同时刻点间差异均有显著性（P〈0．05），插管前即刻降至最低水平，插管后1、3min两者均缓慢上升，均在60以下；RE、SE、BIS三者间有良好的相关性，相关系数在0．995以上。MAP随着麻醉的加深逐渐下降（P〈0．05）。在t2时降至最低水平（P〈0．05），t3时MAP上升，t2比较差异有显著性（P〈0．05），但仍低于t0、t1时刻（P〈0．05），t4时MAP复降至t2时水平（P〉0．05）。HR变化和MAP类似。七氟醚吸入诱导病人反应如拒吸和体动等较明显（约20％）；插管呛咳、颌紧、声门闭合有34例。结论：七氟醚吸入诱导时间较长，体动、拒吸、呛咳、下颌紧、暴露不良等时有存在。其对血流动力学的影响不容忽视。熵和BIS均能准确监测麻醉深度．     

Modern inhalational anesthesia in pediatric maxillofacial surgery

The paper deals with the use of sevoflurane and isoflurane in elective pediatric maxillofacial surgery. Having outlined the major features of anesthesia in this category of patients, the authors emphasize the application of the conception of the minimum alveolar concentration (MAC) and its derivatives (MAC bar and MAC awake) reflecting the analgesic and hypnotic power of an inhalational anesthetic, respectively, and theoretically substantiate the use of certain anesthetic concentrations at particular stages of surgery. The technique described in the paper was used in 82 patients aged 1.5 months to 18 years, undergoing cleft lip and cleft palate repair, residual lip and nose deformation repair, and other elective maxillofacial procedures. The interventions lasted 40 minutes to 8 hours. Sevoflurane was commonly used as an induction agent while isoflurane was applied to maintain anesthesia. The anesthetics were administered at 1 to 1.3 and 0.8 MAC at traumatic and low traumatic stages of surgery, respectively. During the first traumatic period, the dose of fentanyl was not greater than 1.5 and 2.5 microg/kg in old and young children, respectively. Hemodynamics was characterized by moderate controlled hypotension with an average decrease in mean blood pressure by 30% of the age-related value. Emergence occurred 5-15 min after an anesthetic was discontinued. By and large, the technique demonstrated its efficiency and safety in this group of patients.     

EEG and bispectral analysis during inhalational anesthesia in children

Bispectral index (BIS) is a parameter of the depth of anesthesia, but the use of it in children remains discussable. The study was carried out to compare EEG and BIS considering the age of patients during anesthesia with halotane, sevoflurane and consequent combination of sevoflurane and isoflurane. 60 children 3 to 17 years of age, who underwent urological surgeries, were divided into 3 groups (20 patients in each): 1st--halothane group, 2nd--sevoflurane group and 3rd--consequent combination of sevodlurane and isoflurane group. The oxygen: nitrous oxide 1:1 mixture was used in all the mentioned groups. EEG recording (6 channel computerised encephalograph) and BIS monitoring (XP version) was carried out through the whole duration of anesthesia. In the 1st group the gradual reduction of main rhythm was registered on EEG, with slow activity and restoration during awakening. The BIS index values changed from 95-98 to 39-47 with rise to 77-85 during awakening. In the 2nd and 3rd group where sevoflurane was used for anesthesia induction sharpened alpha rhythms, amplitude enlargement and rhythm synchronization were registered on EEG. BIS values changed from 96-99 to 13-38. During the maintenance of anesthesia in the 2nd group BIS values were 30-40 and 72-77 during awakening. In the stage of isoflurane anesthesia in the 3rd group EEG pattern changed towards the rhythm synchronization and slow oscillations in all the leads. The BIS index was 30-39 during maintenance and 70-76 during awakening. The parameters of EEG and BIS in all the investigated groups were proportional to the clinical stage and depth of anesthesia. Based on the clinical data and its comparison to EEG and BIS values it is determined that BIS index can be used for monitoring depth of anesthesia in children.     

Multi-scale sample entropy of electroencephalography during sevoflurane anesthesia

The electroencephalogram (EEG) has been widely applied in the assessment of depth of anesthesia (DoA). Recent research has found that multi-scale EEG analysis describes brain dynamics better than traditional non-linear methods. In this study, we have adopted a modified sample entropy (MSpEn) method to analyze anesthetic EEG series as a measure of DoA. EEG data from a previous study consisting of 19 adult subjects undergoing sevoflurane anesthesia were used in the present investigation. In addition to the modified sample entropy method, the well-established EEG indices approximate entropy (ApEn), response entropy (RE), and state entropy (SE) were also computed for comparison. Pharmacokinetic/pharmacodynamic modeling and prediction probability (P _k ) were used to assess and compare the performance of the four methods for tracking anesthetic concentration. The influence of the number of scales on MSpEn was also investigated using a linear regression model. MSpEn correlated closely with anesthetic effect. The P _k (0.83 ± 0.05, mean ± SD) and the coefficient of determination R ² (0.87 ± 0.21) for the relationship between MSpEn and sevoflurane effect site concentration were highest for MSpEn (P _k : RE = 0.73 ± 0.08, SE = 0.72 ± 0.07, ApEn = 0.81 ± 0.04; R ²: RE = 0.75 ± 0.08, SE = 0.64 ± 0.09, ApEn = 0.81 ± 0.10). Scales 1, 3 and 5 tended to make the greatest contribution to MSpEn. For this data set, the MSpEn is superior to the ApEn, the RE and the SE for tracking drug concentration change during sevoflurane anesthesia. It is suggested that the MSpEn may be further studied for application in clinical monitoring of DoA.     

Analysis of sevoflurane stability during low flow anesthesia

Using the mass spectrometric method we studied the interaction of volatile anesthetic sevoflurane with a CO2 absorber during low flow anesthesia (0.5 l/min fresh gas mixture). The results of measurements of sevoflurane and one of the most toxic breakdown products of sevoflurane CF = C(CF3)-O-CH2F (substance A) throughout the anesthesia in the mode of inhalation-exhalation. The highest recorded concentration of substance A was 65 ppm. Biochemical analysis of blood before and after anesthesia did not show connection with nephropathy and function of liver toxicity.     

Inhalational anesthesia for organ procurement: potential indications for administering inhalational anesthesia in the brain-dead organ donor

Organs needed for transplantation far outweigh their availability. There is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. Current research attributes a great deal of organ damage to autonomic or sympathetic storm that occurs during brain death. Literature searches were performed with the terms brain death, organ donor, organ procurement, anesthesia and organ donor, anesthesia and brain death, anesthesia and organ procurement, inhalational anesthetics and organ procurement, and inhalational anesthetics and brain dead. Additional resources were obtained from reference lists of published articles. The literature review showed there is a lack of published studies researching the use of inhalational anesthetics in organ procurement. No studies have been published evaluating the effect of preconditioning with inhalational agents (administering 1.3 minimal alveolar concentration of an inhalational agent for the 20 minutes before periods of ischemia) in the brain-dead organ donor population. Further studies are required to determine if administration of inhalational anesthetics reduces catecholamine release occurring with surgical stimulation during the organ procurement procedure and whether this technique increases viability of transplanted organs. Anesthetic preconditioning before the ischemic period may reduce ischemia-reperfusion injury in transplanted organs, further increasing viability of transplanted organs.     

七氟烷吸入麻醉与丙泊酚静脉麻醉在小儿扁桃体手术中的应用对比

目的比较丙泊酚和七氟烷应用于小儿扁桃体手术的麻醉效果和安全性。方法选取接受扁桃体手术的患儿52例,随机分为七氟烷组和丙泊酚组各26例,分别采用丙泊酚静脉麻醉和七氟烷吸入麻醉。比较两组患儿麻醉诱导前、手术开始2 min后、手术结束前2 min的血压、心率和血氧饱和度波动情况;比较两组患者的麻醉诱导时间、苏醒时间、定向力恢复时间和不良反应发生情况。结果两组开放静脉一次成功率比较,差异有统计学意义(χ2=8.31,P<0.05)。丙泊酚组患儿的收缩压、舒张压、心率在3个不同时间点比较,差异均有统计学意义(F分别=4.01、6.47、14.03,P均<0.05);七氟烷组患儿的收缩压、舒张压、心率在3个不同时间点比较,差异均没有统计学意义(F分别=0.93、0.90、0.21,P均>0.05)。两组患儿麻醉诱导前的收缩压、舒张压、心率的对比,差异均没有统计学意义(t分别=0.17、0.07、0.54,P均>0.05);手术开始2 min后,丙泊酚组患儿的收缩压、舒张压、心率均明显低于麻醉诱导前(t分别=2.65、2.76、5.08,P均<0.05),手术结束前2 min,丙泊酚组的收缩压、舒张压、心率和麻醉诱导前对比,差异均没有统计学意义(t分别=0.17、1.24、1.12,P均>0.05)。七氟烷组患儿麻醉诱导时间明显长于丙泊酚组,而苏醒时间明显短于丙泊酚组,差异均有统计学意义(t分别=12.31、12.97,P均<0.05)。两组定向力恢复时间比较,差异没有统计学意义(t=0.24,P>0.05)。丙泊酚组诱导时有3例出现气道不通畅,血氧饱和度下降最低达88%,七氟烷组有2例出现屏气,未出现血氧饱和度下降,两组患者术后均有1例出现恶心呕吐。结论七氟烷吸入麻醉在小儿扁桃体手术诱导平稳,患儿易接受,苏醒较快,且不良反应少,是小儿扁桃体手术较为理想的麻醉方式。     

Narcotrend监测下七氟醚对脊柱侧弯矫正术中唤醒的影响

目的:观察Narcotrend麻醉深度监测在脊柱侧弯矫正术中唤醒试验的应用,评价七氟醚对脊柱侧弯矫正术中唤醒试验的影响.方法:60例择期行脊柱侧弯矫正术患者,ASA Ⅰ～Ⅱ级,随机分为七氟醚复合瑞芬太尼静吸复合组(S组)和丙泊酚复合瑞芬太尼静脉麻醉组(P),每组30例.以丙泊酚复合瑞芬太尼靶控输注诱导,诱导插管成功后S组吸入低流量七氟醚(1L/min),P组靶控输注丙泊酚维持麻醉.两组术中均靶控输注瑞芬太尼.根据Narcotrend麻醉深度监测把NI值维持在30 ～ 45调整麻醉深度.记录两组患者手术开始至唤醒试验的时间、手术时间、唤醒时间(从开始唤醒至唤醒成功时间)及苏醒时间(唤醒后清醒时间);观察唤醒试验期间有无不良反应发生,记录两组麻醉前(TO)、术中唤醒前停药时(T1)、唤醒时(T2)、唤醒后10 min (T3)、术毕拔管(T4)时平均动脉压(MAP)、心率(HR)、NI值及呼吸末七氟醚的浓度(ETsev).术后1d,随访患者对唤醒试验及术中其他事件的记忆情况及术中有无疼痛等.结果:两组两组患者均成功完成唤醒试验.两组患者手术开始至唤醒试验的时间、手术时间、唤醒时间和苏醒时间比较差别均无统计学意义(P＞0.05).唤醒期间丙泊酚组有2例发生呛咳,七氟醚组无发生呛咳患者.术后随访两组患者无神经损伤表现,对术中其他事件无记忆.术中两组患者唤醒试验唤醒时(T2)及术毕拔管时(T4)的MAP和HR值较其他时间点均明显升高(P＜0.05);两组患者在唤醒前停药时(T1)及唤醒后10 min(T3)的NI值较其他时间点均明显降低(P＜0.05);七氟醚组在唤醒前停药时(T1)及唤醒后10 min(T3)的ETsev值较其他时间点升高(P＜0.05);两组各时间点的MAP、HR及NI值比较差别无统计学意义(P＞0.05).结论:在Narcotrend麻醉深度监测指导下吸入七氟醚同丙泊酚一样适用于脊柱侧弯矫正术中唤醒麻醉,Narcotrend麻醉深度监测对脊柱矫形术中唤醒时间有预测和指导作用.     

低流量七氟醚麻醉和全静脉麻醉对肝肾功能的影响

目的探讨中等时长的低流量七氟醚麻醉和全静脉麻醉（TIVA）对肝肾功能的影响。方法 100例预期手术时长120~240 min择期行腰椎间盘手术的患者,随机分为七氟醚麻醉组（S组）和TIVA组（T组）,各50例。测定术前和术后24h4、8 h、72 h血清尿素氮（BUN）、肌酐（Scr）、丙氨酸转移酶（ALT）、天冬氨酸转移酶（AST）、乳酸脱氢酶（LDH）和24 h尿糖、尿蛋白和尿肌酐（Ucr）水平。结果 2组患者血清AST、ALT和LDH术前与术后无明显变化。S组患者术后48 h的血清BUN,24 h和48 h的尿糖均较术前有所升高,而术后24 h和48 h的Scr较术前显著升高,但均与T组无显著差异。2组术后Ucr均较术前明显升高,但2组间无显著差异。结论中等时长的低流量七氟醚麻醉与TIVA患者的肝肾功能的影响是相似的。