七氟醚和丙泊酚麻醉对腹腔镜全子宫切除术患者应激反应、血流动力学指标及苏醒时间的影响

目的探讨七氟醚和丙泊酚麻醉对腹腔镜全子宫切除术患者应激反应、血流动力学指标及苏醒时间的影响。方法回顾性选取本院行腹腔镜全子宫切除术的80例患者,依据麻醉方法将其分为七氟醚组(n=40)和丙泊酚组(n=40)。比较两组的麻醉效果。结果T2、T3、T4时,两组的Cor、AngⅡ、血糖水平均明显高于T1时,但七氟醚组的Cor、AngⅡ、血糖水平明显低于丙泊酚组(P<0.05)。两组术中的BIS、HR、MAP比较,差异无统计学意义(P>0.05)。七氟醚组的术毕苏醒时间、自主呼吸恢复时间、言语应答时间、定向力恢复时间均短于丙泊酚组(P<0.05)。七氟醚组的术后躁动发生率明显低于丙泊酚组(P<0.05)。结论腹腔镜全子宫切除术中应用七氟醚麻醉较丙泊酚更能减轻患者的应激反应,使患者术中血流动力学保持稳定,缩短术毕苏醒时间,减少患者术后躁动的发生。     

Changes in intraocular pressure during surgery in the lateral decubitus position under sevoflurane and propofol anesthesia

Intraocular pressure (IOP) has been shown to change with body position. Several studies have shown that the lateral decubitus position (LDP) is associated with a significant increase in IOP in the dependent eye. However, whether anesthetic agents alter IOP in the LDP remains unclear. This study investigated the effect of sevoflurane and propofol anesthesia on IOP in the LDP. A total of 28 patients undergoing surgery in the LDP were included. Patients were randomly allocated to sevoflurane or propofol groups. IOP in both eyes was recorded and compared between groups at five time points: after anesthesia induction, after endotracheal intubation, at 5 min and 1 h after a positional change to the LDP, and 5 min after returning to the supine position. In the sevoflurane group, IOP was significantly increased in both dependent and non-dependent eyes 1 h after changing to the LDP. In the propofol group, IOP decreased in both dependent and non-dependent eyes after tracheal intubation, but did not increase after changing to the LDP. The number of patients in whom IOP increased to ≥28 mmHg was greater in the sevoflurane group than in the propofol group. Propofol may be better than sevoflurane for the maintenance of anesthesia in the LDP. Monitoring of IOP in the LDP might help avoid ophthalmic complications.     

七氟烷与丙泊酚联合瑞芬太尼对脊椎骨折患者炎症因子水平及镇痛效果的影响

目的 探讨七氟烷与丙泊酚联合瑞芬太尼对脊椎骨折患者炎症因子水平及镇痛效果的影响.方法 选取我院2018年10月至2020年10月脊柱外科收治的112例脊椎骨折患者作为研究对象,根据不同麻醉方式将其分为对照组和研究组,各56例.对照组给予七氟烷联合瑞芬太尼麻醉,研究组给予丙泊酚联合瑞芬太尼麻醉.比较两组的麻醉应激反应指标水平、麻醉相关指标、血清炎性因子水平、镇痛效果及不良反应发生情况.结果 研究组患者不同时间点的MAP、HR、SpO2、NE、E、Col水平比较,差异无统计学意义(P>0.05);对照组患者不同时间点的MAP、HR、NE、E、Col水平比较,差异具有统计学意义(P<0.05).研究组的恢复自主呼吸时间、拔管时间、苏醒时间、定向力恢复时间及镇痛药追加次数均优于对照组(P<0.05).术后,两组的IL-6、CRP、VCAM-1、ICAM-1、E-selectin、P-selectin水平均低于术前(P<0.05),但组间比较,差异无统计学意义(P>0.05).研究组拔管即刻及术后0.5、6、12、24 h的疼痛评分均低于对照组(P<0.05).两组的不良反应总发生率比较,差异无统计学意义(P>0.05).结论 丙泊酚联合瑞芬太尼可有效提高麻醉及镇痛效果,改善患者术后苏醒状态,且对麻醉应激反应指标影响小,安全性高,对保证脊椎骨折患者手术效果及术后恢复均有积极意义.     

七氟醚与丙泊酚对先天性髋关节脱位手术患儿凝血功能及术后恢复的影响

目的 探讨七氟醚与丙泊酚对先天性髋关节脱位手术患儿凝血功能及术后恢复的影响.方法 以本院2017年6月～2020年6月收治的92例先天性髋关节脱位患儿为研究对象,将受试者根据随机抽样法分为七氟醚组和丙泊酚组,每组各46例,七氟醚组和丙泊酚组患儿在麻醉诱导及维持中分别给予七氟醚与丙泊酚,比较2组患儿在麻醉不同时间点内各血...     

七氟烷和丙泊酚对急诊外伤术后创伤后应激障碍发病的影响

目的:研究两种主要全身麻醉药物丙泊酚、七氟烷对急诊外伤患者术后创伤后应激障碍（PTSD）发病率的影响。方法:选择160例在全麻下接受急诊手术的外伤患者,随机（随机数字表法）分为丙泊酚组和七氟烷组,两组患者分别使用丙泊酚和七氟烷维持麻醉,采集围手术期各项临床数据。术后1个月使用PCL-5量表评估两种患者PTSD发生率差异,分别对两组患者麻醉前受伤时间和PCL-5量表评分进行Spearman相关分析,采用logistic回归分析进一步研究PTSD发生危险因素。结果:术后1个月,丙泊酚组患者PTSD发生率显著高于七氟烷组（24% vs 10.8%, P=0.034）,丙泊酚组麻醉前受伤时间与PCL-5量表评分程负相关（ r=0.229, P<0.01）,而七氟烷组麻醉前受伤时间与PCL-5量表评分无相关性（ r=0.001, P=0.804）。通过logistic回归分析发现,丙泊酚的使用是PTSD发生率的独立危险因素（ P=0.004）。 结论:在外伤患者急诊手术中,选择七氟烷进行全身麻醉相比丙泊酚麻醉对减少术后PTSD发生具有一定应用价值。     

雷米芬太尼麻醉对胃癌病人术后镇痛的影响

目的评价雷米芬太尼麻醉对胃癌病人术后镇痛的影响。方法选择拟全身麻醉下胃癌根治手术病人60例，随机分为七氟烷静吸复合全麻（S组）和雷米芬太尼、丙泊酚全凭静脉麻醉（R组）两组，每组30例。病人在麻醉恢复室停留1h，并进行术后镇痛，采用视觉模拟评分法WAS）评价疼痛程度．当VAS评分i〉3分时开始静脉注射舒芬太尼0．1ug／kg，10min后可重复，直至VAS评分≤2分，接静脉镇痛泵。记录患者术后48h的VAS评分；计算术后1h舒芬太尼用量、术后镇痛1～48h内有效按压次数和镇痛药消耗总量：同时观察恶心、呕吐和术后烦躁的发生情况。结果与S组比较，R组在术后0．25h、0．5hVAS评分升高，术后1h舒芬太尼用量增加，差异均有统计学意义（t分别=8．16、7．09、8．89，P均〈0．05），R组在术后1h内舒芬太尼用量明显高于增加S组，差异有统计学意义（t=8．89，P〈0．05）；而术后1-48h内有效按压次数和镇痛药消耗总量比较，差异均无统计学意义（t分别=0．66、0．50，P均〉0．05）。结论雷米芬太尼、丙泊酚全凭静脉麻醉进行手术患者在术后1h内存在痛觉过敏现象，术后应及时、足量的应用阿片类药物或其它方法来预防和处理。     

三种不同麻醉方式对小儿术后躁动的影响

[目的]比较瑞芬太尼加异丙酚全凭静脉麻醉、七氟醚吸入麻醉、静吸复合麻醉三种不同麻醉方式对小儿术后躁动的影响.[方法]将60例2~5岁实施腺样体切除的患儿随机分为三组（每组20例）.瑞芬太尼加异丙酚全凭静脉组（P 组）、七氟醚组（S组）、静吸复合组（R 组）,术后送入术后复苏室（PACU）.观察各组的躁动发生率、苏醒时间和PACU停留时间.[结果]P组和R组的躁动发生率显著低于S 组（20%和35% vs 70%,P〈0.01）.与R组比较,P组、S组的苏醒时间明显延长（P〈0.01或P〈0.05）;PACU停留时间亦显著增加（P〈0.01或P〈0.05）.[结论]瑞芬太尼加异丙酚全静脉麻醉可有效的抑制小儿术后躁动的发生率,但是联合七氟醚吸入麻醉可以得到更好的苏醒质量.     

异丙酚和七氟醚对老年乳腺癌患者术中应激反应和术后认知功能的影响

目的 探讨异丙酚和七氟醚麻醉对老年患者术中应激反应及术后认知功能的影响.方法 乳腺癌手术老年患者60 例,分别接受异丙酚(30 例)和七氟烷(30 例)麻醉,比较两组术中应激反应、术后简易精神状态量表评分、术后认知功能障碍发生率.结果 丙泊酚组在麻醉诱导后3 min皮质醇浓度明显低于入室后(t=2.15,P＜0.05);七氟醚组在麻醉诱导后3 min、插管后1 min、切皮后2 min、关腹后及拔管后皮质醇浓度均高于入室后(t分别=2.25、2.13、1.98、2.99、3.15,P均＜0.05);七氟醚组各时间点的血液中皮质醇浓度均高于丙泊酚组(t分别=3.21、2.95、3.42、3.55、3.54,P均＜0.05);丙泊酚组术后认知功能障碍发生率为6.70%,七氟醚组为13.30%,两组比较,差异有统计学意义(χ2=50.28,P＜0.05).结论 丙泊酚能有效抑制全麻术中应激反应,两组均可引起老年患者术后早期短暂的认知功能下降,但异丙酚较七氟烷能减少认知功能障碍的发生率.     

The effects of anesthetic agents on pupillary function during general anesthesia using the automated infrared quantitative pupillometer

Pupil reactivity can be used to evaluate central nervous system function and can be measured using a quantitative pupillometer. However, whether anesthetic agents affect the accuracy of the technique remains unclear. We examined the effects of anesthetic agents on pupillary reactivity. Thirty-five patients scheduled for breast or thyroid surgery were enrolled in the study. Patients were divided into four groups based on the technique used to maintain anesthesia: a sevoflurane–remifentanil (SEV/REM) group, a sevoflurane (SEV) group, a desflurane–remifentanil (DES/REM) group, and a propofol–remifentanil (PRO/REM) group. We measured maximum resting pupil size (MAX), reduction pupil size ratio (%CH), latency duration (LAT) and neurological pupil index (NPi). A marked reduction in MAX and %CH compared with baseline was observed in all groups, but LAT was unchanged during surgery. NPi reduced within the first hour of surgery in the SEV/REM, SEV, and DES/REM groups, but was not significantly different in the PRO/REM group. Compared with the PRO/REM group, mean %CH and NPi in patients anesthetized with SEV/REM, SEV or DES/REM were markedly lower at 1 h after surgery had commenced. There was no correlation between NPi and bispectral index. Fentanyl given alone decreased pupil size and %CH in light reflex, but did not change the NPi. NPi was decreased by inhalational anesthesia not but intravenous anesthesia. The difference in pupil reactivity between inhalational anesthetic and propofol may indicate differences in the alteration of midbrain reflexs in patients under inhalational or intravenous anesthesia.     

七氟烷复合瑞芬太尼用于腹腔镜胆囊切除手术麻醉的临床观察

目的 观察七氟烷复合瑞芬太尼用于腹腔镜胆囊切除手术的麻醉效果。方法60例美国麻醉学会手术前分级（ASA）Ⅰ-Ⅱ级拟行腹腔镜胆囊切除手术的成年患者，随机分成七氟烷组和对照组。各组30例，术前用药，麻醉诱导相同。麻醉维持：七氟烷组全程吸入七氟烷，浓度2％-4％，对照组持续静脉泵入丙泊酚6—10mg／（kg·h），两组均在麻醉诱导后静脉泵入瑞芬太尼0．05—0．40μg／（kg·min）辅助麻醉，术中根据生体征变化和手术刺激强度调控麻醉深度。观察术中生命体征变化、麻醉效果、苏醒时间、苏醒程度和不良反应。结果两组麻醉效果满意，术中血压、心率改变比较无明显差异。七氟烷组瑞芬太尼输注速率和总量明显低于对照组（P〈0．05），两组苏醒时间和苏醒程度评分无显著差异（P〉0．05）。结论七氟烷复合瑞芬太尼静吸麻醉效果好，术中循环稳定、苏醒快捷，是腹腔镜胆囊切除手术理想的麻醉方法。     

Use of propofol and emergence agitation in children: a literature review

Emergence agitation (EA) is an important issue in pediatric anesthesia. This phenomenon arises more frequently with the use of inhalational agents. Three commonly used general anesthesia techniques in children were evaluated as to the associated incidence of emergence reactions. An extensive literature review was performed to evaluate these anesthetic practices and the occurrence of EA in young children. Relevant literature was obtained from multiple sources, including professional journals, professional websites, and textbooks. Three categories of anesthesia techniques were reviewed: sevoflurane inhalational general anesthetic, Emerpropofol as an adjunct to sevoflurane general anesthetic, and propofol total intravenous anesthesia (TIVA) techniques. Several variables within each category were evaluated with respect to the outcome of EA: prevention, intraoperative adjuncts, type of surgery, and patient-related factors. According to the literature evidence base, there is an advantage to either propofol TIVA or adjunctive propofol with sevoflurane (compared with sevoflurane alone). We conclude, based on the current evidence, that the use of propofol is associated with a reduction in the incidence of emergence agitation.     

七氟醚用于小儿先天性心脏病手术的临床研究

目的：观察、比较七氟醚吸入麻醉与全凭静脉麻醉在小儿先天性心脏病手术中的应用。方法：40例择期行先天性心脏病房室缺矫治术患儿,随机分为七氟醚组和全凭静脉麻醉组（TIVA组）,每组各20例。七氟醚组患儿以七氟醚吸入诱导,复合小剂量芬太尼、咪达唑仑、维库溴铵,麻醉维持为七氟醚吸入＋芬太尼、维库溴铵;静脉组患儿肌注氯胺酮后,以芬太尼、咪达唑仑、维库溴铵诱导,维持使用丙泊酚持续泵入＋芬太尼、维库溴铵。比较两组术中各时点血流动力学变化、手术麻醉时间与芬太尼、维库溴铵用量、术后呼吸支持时间、清醒时间、拔管时间,比较两组不良反应发生情况。结果：两组患儿均维持比较稳定的血流动力学状态。七氟醚组芬太尼与维库溴铵用量明显低于TIVA组,呼吸支持时间、清醒时间、拔管时间明显低于TIVA组。七氟醚组2例术后发生躁动,3例发生恶心,稍高于TIVA组。结论：七氟醚应用于小儿先心房室缺矫治术,可提供稳定的血流动力学状态,并降低芬太尼与肌松剂用量,实现术后早拔管、改善患者预后、降低医疗费用。     

七氟醚与丙泊酚对老年患者全麻术后认知功能影响的比较

目的 比较七氟醚与丙泊酚麻醉对老年患者术后认知功能的影响.方法 选择ASAⅠ～Ⅱ级,无糖尿病、心脑血管疾病且未服用影响神经精神系统功能的药物在苏州大学附属第一医院择期全身麻醉下行人工髋关节置换手术的老年患者（65～80岁）40例,随机分为2组,Ⅰ组（n=20）患者以七氟醚、芬太尼、维库溴铵全麻诱导并维持麻醉;Ⅱ组（n=20）患者以靶控输注丙泊酚、芬太尼、维库溴铵全麻诱导并维持麻醉.术中监测麻醉期间心率、无创血压、脉氧、呼末二氧化碳值、脑电双频指数,并根据以上监测调节麻醉深度;术后镇痛采用病人自控静脉镇痛,镇痛效果采用视觉模拟评分（visual analogue scale,VAS）评估.术前、术后1d、7d简易智力状态检查（mini-mental state examination,MMSE）评分.结果 两组患者一般资料、麻醉时间及术后镇痛效果之间差异均无显著性（P〉0.05）;两组患者术后1d及7d与术前比较简易智力状态检查评分差异无显著性（P〉0.05）.结论 七氟醚与丙泊酚麻醉对老年患者术后认知功能的影响无显著差异.     

七氟醚复合丙泊酚麻醉对MCI大鼠胫骨骨折术后认知功能的影响及机制

目的探讨七氟醚复合丙泊酚对轻度认知功能障碍(MCI)大鼠胫骨骨折术后认知功能的影响及其影响机制。方法 2019年选取52只SD大鼠随机分为:对照组(10只),七氟醚组、丙泊酚组、复合麻醉组(各14只)。对照组仅切开皮肤后缝合,其他3组以结扎双侧颈总动脉法制备MCI大鼠模型,然后将模型制备成功的七氟醚组3%七氟醚吸入3 h;丙泊酚组尾静脉输注丙泊酚3 h(40 mg/kg),复合麻醉组吸入1. 7%七氟醚并给予丙泊酚(20 mg/kg),3 h。然后在骨折切开复位固定术后7 d,做旷场实验、Y迷宫实验测定大鼠认知功能,测定海马CA1区计数神经元存活数量。采用免疫荧光法和Western blot法测定海马核不均一性核糖核蛋白A2(hnRNP A2)与γ-氨基丁酸A型受体α1亚基膜蛋白(GABAA-α1)的表达。结果 4组旷场实验的活动总路程、中央区活动时间差异无显著性(P> 0. 05);Y迷宫实验中,七氟醚组、丙泊酚组新异臂停留时间百分比低于对照组和复合麻醉组(P <0. 05),但对照组与复合麻醉组、七氟醚组与丙泊酚组差异无显著性(P>0. 05)。七氟醚组、丙泊酚组海马CA1区存活的神经元数目比低于对照组和复合麻醉组(P <0. 05),对照组和复合麻醉组、七氟醚组与丙泊酚组差异性无显著性(P <0. 05);与对照组比较,七氟醚组、丙泊酚组和复合麻醉组的hnRNP A2表达上调(P <0. 05),七氟醚组、丙泊酚组GABAA-α1表达下调,复合麻醉组差异无显著性;与复合麻醉组比较,七氟醚组、丙泊酚组的hnRNP A2表达上调,GABAA-α1表达下调,差异有统计学意义(P <0. 05)。结论七氟醚复合丙泊酚麻醉不会加重MCI大鼠胫骨骨折术后认知功能,其机制可能与七氟醚复合丙泊酚麻醉稳定GABAA-α1的表达、上调hnRNP A2表达有关。     

心功能Ⅱ～Ⅲ级老年患者的全麻应用瑞芬太尼联合异丙酚双通道靶控输注临床效果观察

目的 探讨对心功能II～III级老年患者采用瑞芬太尼联合异丙酚双通道靶控输注全麻的临床效果.方法 120例心功能II～III级行胆囊切除手术老年患者随机分为等量两组,实验组进行瑞芬太尼联合异丙酚双通道靶控输注全麻,对照组进行七氟醚吸入全麻,监测患者各时点血液动力学变化,记录起效、苏醒时间和拔管后不良反应情况.结果 实验组各时点的血液动力学变化与对照组相比均无显著差异,起效及苏醒时间均短于对照组,除心动过缓无显著差异外,其他不良反应均少于对照组(P<0.05).结论 老年患者应用瑞芬太尼联合异丙酚双通道靶控输注全麻,能抑制心血管应激反应,维持血液动力学的稳定,且恢复迅速,值得推广使用.     

Open-label, prospective, randomized comparison of propofol and sevoflurane for laryngeal mask anesthesia for magnetic resonance imaging in pediatric patients

Background: Magnetic resonance imaging (MRI) for pediatric patients often requires deep sedation or anesthesia because they must remain completely immobile for a relatively long period to obtain high-quality images. Objective: The aim of this study was to compare the effectiveness of propofol IV or inhalation of sevoflurane anesthesia with the laryngeal mask airway (LMA) for children undergoing MRI. Methods: Children aged 2 to 6 years with American Society of Anesthesiologists' physical status of I to II who were scheduled for MRI were enrolled in this study and randomly divided into 2 groups. The propofol group was administered propofol 4 mg/kg IV followed by infusion of 150 microg/kg . min(-1). Patients in the sevoflurane group were induced with sevoflurane 8% by face mask and maintained with an air/oxygen mixture followed by sevoflurane 1.5%. Data recorded included age, weight, scan time, LMA insertion, removal, and recovery times, hemodynamic parameters, complications, pediatric anesthesia emergence delirium (PAED) scale score, child movement, and MRI interruption. A higher PAED score indicated a higher level of delirium. Results: Eighty-eight children were enrolled and randomized to treatment. Nine children were excluded from analysis due to protocol violations. After completion of the study, there were 37 children in the propofol group (male/female, 18/19; mean [SD] age, 42.1 months; weight, 15.2 [4.9] kg; scan time, 20.5 [4.6] min) and 42 in the sevoflurane group (male/ female, 15/27; mean [SD] age, 44.4 [26.1] months; weight, 15.1 [5.2] kg; scan time, 20.6 [4.8] min). No significant differences were found between the study groups with regard to age, weight, scan time, and hemodynamic parameters at baseline and during the study period. Mean LMA insertion, removal, and recovery times were significantly longer in the propofol group (4.8, 5.2, and 8.8 minutes, respectively) than in the sevoflurane group (3.3, 2.5, and 3.9 minutes, respectively) (P < 0.05). The mean PAED score in the propofol group was significantly lower than that in the sevoflurane group (mean [SD], 6.1 [4.0] vs 10.5 [3.7]; P < 0.05). The percentage of MRI interruption in the propofol group was significantly higher than that in the sevoflurane group (4 [11%] vs 0, respectively; P < 0.05). No episodes of hypotension or bradycardia occurred during the study, and alterations in the propofol infusion rate or sevoflurane concentration were not necessary. One child vomited in the sevoflurane group during the postoperative period. Conclusions: This small study found that sevoflurane, at the doses used in this study, provided shorter induction and faster recovery times than IV propofol for LMA anesthesia in these selected children undergoing MRI. The percentage of MRI interruption in the propofol group was significantly higher than that in the sevoflurane group. Sevoflurane was associated with a significantly higher score on the PAED scale, indicating greater emergence delirium.     

老年患者日间手术后认知功能障碍的临床研究

目的本研究评估老年患者在日间手术后24h内POCD发生,及血清神经损伤标志物-S-100蛋白和神经特异性烯醇化酶变化。方法老年患者30例,随机分为异丙酚静脉麻醉组、七氟醚吸人麻醉组;观察在日问手术后24h内POCD的发生,及血清神经损伤标志物S-100蛋白和神经特异性烯醇化酶变化。结果POCD发生较对照组高,P=0．03。S-100蛋白和神经特异性烯醇化酶与对照组及术前没有显著变化。结论老年患者在日间手术后24h内POCD发生,较以往报道的大手术后7d内发生高;S-100蛋白和神经特异性烯醇化酶水平无变化。     

丙泊酚与七氟醚对单肺通气下肺癌肺叶切除术患者围术期肺功能的影响比较

目的比较丙泊酚与七氟醚对单肺通气下肺癌肺叶切除术患者围术期肺功能的影响。方法选取我院收治的86例行单肺通气下肺癌肺叶切除术患者,将其随机分成七氟醚组(43例,采用七氟醚维持麻醉)和丙泊酚组(43例,采用丙泊酚维持麻醉)。比较两组患者各时间点的血流动力学指标、肺功能指标及MDA、MMP-9水平。结果两组患者各时间点的CO、CVP、MAP、HR比较,差异均无统计学意义(P>0.05)。T1、T2、T3时,丙泊酚组的Qs/Qt低于七氟醚组(P<0.05);T2、T3时,丙泊酚组的RI低于七氟醚组(P<0.05);T3时,丙泊酚组的A-aDO2低于七氟醚组(P<0.05)。T3时,丙泊酚组的MDA、MMP-9水平均低于七氟醚组(P<0.05)。结论丙泊酚麻醉对单肺通气下肺癌肺叶切除术患者肺功能的损伤程度小于七氟醚麻醉,且过氧化程度、炎性反应较轻。     

地佐辛配伍丙泊酚联合喉罩用于纤维支气管镜检查的临床研究

目的 评价地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查的效果。 方法 将2012年10月－12月拟行纤维支气管镜检查,且按美国麻醉医师协会分级Ⅰ或Ⅱ级的60例患者,随机分为芬太尼组（F组）、地佐辛组（D组）、生理盐水组（N组）,每组20例。采用双盲法给药,静脉注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理盐水0.1 mL/kg,5 min后3组缓慢静脉注射丙泊酚2 mg/kg诱导后置入喉罩,术中保留自主呼吸,持续泵入丙泊酚4～6 mg/（kg·h）维持麻醉,观察3组患者诱导前（T0）、诱导后时（T1）、纤维支气管镜操作时（T2）、术毕时（T3）及拔除喉罩时（T4）的生命体征,记录丙泊酚总用量、苏醒时间、苏醒时的呼吸道疼痛视觉模拟评分（VAS）,记录术中及术后有关并发症的发生情况。 结果 与N组相比,D、F两组丙泊酚总用量减少、苏醒时间缩短,头昏及术中体动发生率、VAS评分明显降低（P＜0.05）;呼吸暂停的发生率D组最低（P＜0.05）;恶心、呕吐的发生率F组最高（P＜0.05）。 结论 地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查,麻醉效果满意,术后镇痛效果好,值得临床推广。     

瑞芬太尼复合丙泊酚对 LC 术中血流动力学的影响

【目的】观察瑞芬太尼复合丙泊酚对腹腔镜胆囊切除术（LC ）术中患者血流动力学的影响。【方法】在本院接受LC的患者110例，根据其麻醉方式分为丙泊酚麻醉组和复合麻醉组，其中丙泊酚组给予丙泊酚静脉麻醉，复合麻醉组给予瑞芬太尼复合异丙酚麻醉。观察比较两组患者手术中血流动力学以及麻醉效果的差异。【结果】两组患者入手术室时（T0）收缩压（SBP）、舒张压（DBP），平均动脉压（MAP），血氧饱和度（SpO2）水平相比较差异无显著性（P＞00．5），丙泊酚组麻醉诱导即刻（T1）、气管插管即刻（T2）、切皮即刻（T3）、手术中（T4）、缝皮即刻（T5）和拔管即刻（T6）患者的DBP和MAP水平较复合麻醉组低（P＜00．5），且波动明显，而两组患者的SpO2水平相比较差异无显著性（P＞00．5）；两组患者术后12 h和24 h的VAS得分和Ramsay得分均较术后4 h降低，且手术后4 h、12 h和24 h ，复合麻醉组VAS 得分低于对照组（P＜00．5），两组患者的Ramsay得分相比较差异无显著性（P＞00．5）；复合麻醉组患者唤醒时间和拔管时间均较丙泊酚组短，且差异具有显著性（P＜00．5）。【结论】瑞芬太尼复合丙泊酚对LC术中血流动力学影响较小，且麻醉效果较好，值得在临床推广应用。