不同诱导方式的七氟烷吸入麻醉的临床效果分析

目的 比较肺活量呼吸法、潮气量呼吸法以及逐渐增加浓度法三种不同方式诱导的七氟烷在全身麻醉中的临床疗效以及不良反应的发生率.方法 将我院普外科于2011年1月至2012年12月收治的拟进行气管插管全麻择期手术90例患者根据手术顺序循环归入肺活量呼吸组（甲组,n=30）、潮气量呼吸组（乙组,n=30）和逐渐增加浓度组（丙组,n=30）,分别以肺活量呼吸法、潮气量呼吸法以及逐渐增加浓度法吸入七氟烷诱导麻醉,静脉泵入1.5～2mg·kg-1·h-1丙泊酚及1 ～ 2μg·kg-1·h-1瑞芬太尼维持麻醉.观察并记录诱导前（T1）、睫毛反射消失（T2）、插管前（T3）、插管后1 min（T4）、3min（T5）和5min（T6）等6个时间点患者的舒张压（DBP）、收缩压（SBP）、平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）和肌肉松弛效果等指标,评价不同诱导方式的七氟烷在吸入麻醉中的临床疗效,观察不良反应计算其发生率.结果 T1 3组患者所有指标差异均无统计学意义（P＞0.05）.甲组、乙组、丙组患者的睫毛反应消失时间分别为（83.2±23.18）s、（110.3±26.74）s、（142.6±25.14）s.3组患者间睫毛反应消失时间差异均存在统计学意义（甲组与乙组,t=4.214,P＜0.05;甲组与丙组,t=6.355,P＜0.05;乙组与丙组,t=4.521,P＜0.05）.患者麻醉后DBP、SBP和MAP及HR均有下降,与T1时间点相比差异均具有统计学意义（P＜0.05）,但同一时间点3组间比较差异无统计学意义（P＞0.05）;麻醉后3组患者的SpO2与T1时间点相比具有明显升高,差异具有统计学意义（P＜0.05）,但同一时间点内各组SpO2相比较差异无统计学意义（P＞0.05）;3组患者肌松恢复时间、不良反应发生率的差异比较无统计学意义（甲组10.0％,乙组和丙组均为6.7％,x2=0.310,P＞0.05）.结论 3种不同方式诱导的七氟烷在全身麻醉中的临床疗效及不良反应的发生率差异不大,肺活量呼吸法的诱导时间最短.

Anesthetic effect of inhaling Sevoflurane by different induction methods

Objective To compare the anestheticl effects of inhaling sevoflurane by different induction methods.Method 90 patients undergoing endotracheal intubation for elective operation from January 2012 to December 2012 in the Department of General Surgery were randomly divided into a vital capacity technique group （Group Ⅰ,n=30）,a tidal volume technique group （Group Ⅱ,n=30）,and an increasing concentration group （Group Ⅲ,n=30）.8% of sevoflurane and 4L/min oxygen flow were used for inducing anesthesia （for Group Ⅲ,the sevoflurane concentration was gradually increased by 1% every 25 s）.1.5-2.0 mg · kg-1 · h-1 propofol and 1-2 μ g · kg-1 · h 1 remifentanil were used for continuous anesthesia.Diastolic blood pressure （DBP）,systolic blood pressure （SBP）,mean arterial pressure （MAP）,heart rate （HR）,pluse oxygen saturation （SpO2）,muscle relaxant effects,and adverse effects were observed before and after the induction.Results There were no statistical differences in all the indexes before anethesia induction（T1） between the three groups.The disappearing times of eyelash reflex were （83.2 ± 23.18） s,（110.3 ± 26.740 s,and （142.6 ± 25.14） s in Group Ⅰ,Group Ⅱ,and Group Ⅲ,respectively,with stitistical differences between each two groups.The DBP,SBP,MAP,and HR of the three groups decreased after anethesia （compared to T1,P〈0.05）,but there were no statistical differences between the three group at the same time （P〉0.05）.The SpO2 of the three groups increased after anethesia（compared to T1,P〈0.05）,but with no statistical difference between the three groups at the same time （P〉0.05）.Patients in the three groups showed similar restored times of muscular relaxation.There was no statistical differences in the incidence of adverse reaction between the three groups （10.0% for Group Ⅰ,6.7% for both Group Ⅱ and Group Ⅲ,x 2=0.310,P〉0.05）.Conclusions There were no statistical differences in anesthetic effect and between the three induction methods of inhaled sevoflurane.The induction time of vital capacity technique was the shortest.