先天性脊柱畸形矫形术两种麻醉方法的研究

目的：探讨先天性脊柱畸形矫形术的两种麻醉方法的临床效能。方法：选择18例半椎体所致先天性脊柱畸形行一期后路半椎体切除内固定术病人，随机分为2组：A组采用丙泊酚全凭静脉麻醉．B组采用丙泊酚＋异氟烷静吸复合麻醉。连续监测记录两组病人诱导前、唤醒试验前10min、唤醒试验前5min、唤醒时、唤醒试验后加深麻醉时、手术结束时各个时段点的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、呼吸（R）。观察比较两组的唤醒时间、唤醒躁动例数、术中知晓例数及术后拔管时间。在上述各个时点采周围静脉血2ml，测定外周血皮质醇、生长激素、内皮素浓度。结果：A组在唤醒前5min及唤醒时HR明显低于B组，B组唤醒时点MAP变化明显高于A组（P〈0．05），A组唤醒时间及术中知晓例数明显少于B组（P〈0．05）。B组血浆皮质醇浓度在唤醒前5min、唤醒时较诱导前增高（P〈0．05）。A组血浆生长激素浓度在唤醒时较诱导前增高（P〈0．05）。B组血浆生长激素浓度在唤醒前5min较诱导前增高（P〈0．05）。A组血浆内皮素浓度在唤醒前10min、唤醒前5min、唤醒时明显低于B组（P〈0．05）。在唤醒前10min、加深麻醉后时点两组血浆内皮素浓度较诱导前减少（P〈0．05）。结论：（1）脊柱畸形矫形术采用丙泊酚全凭静脉麻醉术中血液动力学稳定，麻醉调控性良好，病人清醒更快更完全，可有效预防术中知晓，且临床使用简单方便。（2）采用丙泊酚全凭静脉麻醉可明显减轻脊柱畸形矫形术行唤醒试验时较强的应激反应，能使病人更平稳渡过手术期，具有较好的临床使用价值。

Comparison of two anesthesia methods used in scoliosis surgery

Objective: To investigate the effects of two methods of anesthesia in scoliosis surgery.Methods: Eighteen patients who were undergoing elective scoliosis surgery were randomly divided into two groups: group A total intravenous propofol anesthesia(n=9) and group B combined propofol-isoflurane anesthesia(n=9).Method of awaking test: Stopping all of the drugs 10 minutes before awaking test and wakening the patient till the spontaneous respiratory recovering.After awaking test,deepen the anesthesia.HR MAP SpO_2 and R were recorded at the point of before induced,10 minutes before awaking test,5 minutes before awaking test,awaking time,anesthesia again after awaking test and the end of operation.Measured the plasma concentration of cortisol,auxin,and endothelin at each point.Compared the wakening times in(awaking) test,the number of fidget in awaking,the number of awareness at interoperation and the times of extubation.Results: In group A,HR is lesser than that in group B at the point of 5 minutes before awaking test and awaking time,the change of MAP were lower at the awaking time,the wakening times in(awaking) test and the number of awareness are lower than that in group B.The concentration of plasma cortical at the point of 5 minutes before awaking test and awaking time,the concentration of auxin at the point of 5 minutes before awaking test are higher than the point of before intubation in group B.In group A the concentration of auxin at the point of awaking time is lower than the point of before intubation.The concentration of endothelin in group A is higher than that in group B at the time of 10 minutes before awaking test,5 minutes before awaking test and awaking time,and at the time of anesthesia again after awaking test is lower than before induced in both groups.Conclusion: Total intravenous propofol anesthesia in scoliosis surgery have some adevantagements:(1) It have more stability of hemodynamic and easily controlled,faster awaking and can effective prevented awareness in surgery,more convenient used in clinical.(2) It can decrease stress response in awaking test and made patients more stableness in operation.