两种快通道麻醉方法在肾移植手术的应用比较

目的比较两种快通道麻醉方法在肾移植手术的应用效果。方法 36例符合美国麻醉师协会（American Society of Anesthesiologists,ASA）分级Ⅲ~Ⅳ级的终末期肾病拟行肾移植术患者,采用随机数字法将患者随机分为Ⅰ组和Ⅱ组各18例。两组麻醉诱导用药相同。Ⅰ组吸入0.8%-1.8%七氟醚,使用小剂量顺式阿曲库胺0.05-0.10 mg/（kg.h）]持续输注和常规剂量瑞芬太尼0.1-1.0μg/（kg.min）]维持麻醉,预计手术结束前30 min停用顺式阿曲库胺,结束前15 min停止使用七氟醚,并将瑞芬太尼减低至维持量的1/10-1/5用至拔除气管导管。Ⅱ组使用丙泊酚5-12 mg/（kg.h）]全凭静脉麻醉,以常规剂量顺式阿曲库胺0.1-0.2 mg/（kg.h）]及瑞芬太尼0.1-1.0μg/（kg.min）]维持麻醉,预计手术结束前30 min停用顺式阿曲库胺,手术结束后观察两组患者的睫毛反射时间、睁眼时间、拔管时间、术中知晓例数以及苏醒期躁动评分。结果Ⅰ组与Ⅱ组的睫毛反射时间、睁眼时间、拔管时间比较差异无统计学意义（均为P〉0.05）。两组患者均未出现术中知晓。Ⅰ组的躁动发生率明显低于Ⅱ组（P〈0.05）。Ⅰ组的顺式阿曲库胺、瑞芬太尼用量均明显少于Ⅱ组（均为P〈0.05）。结论七氟醚＋瑞芬太尼＋顺式阿曲库铵或丙泊酚＋瑞芬太尼＋顺式阿曲库铵这两种快通道麻醉方法用于肾移植手术均具有可控性良好、安全性高、患者苏醒迅速等特点,而七氟烷＋瑞芬太尼＋顺式阿曲库铵的组合更节省药物用量,且苏醒质量更高。

Comparison of two kinds of fast track anesthesia for renal transplantation

Objective To compare the application effect of two kinds of fast track anesthesia for renal transplantation.Methods Thirty-six patients with Ⅲ-Ⅳ grade end-stage renal failure according to American Society of Anesthesiologists（ASA） grade who underwent renal transplantation were randomly divided into group Ⅰ（n=18）and group Ⅱ（n=18）.Anesthetic induction agents and methods were the same in the two groups.In group Ⅰ,0.8 %-1.8 % sevoflurane was imbibed,and small dose of cisatracurium0.05-0.10 mg/（kg·h）]and conventional dose of remifentanil0.1-1.0 μg/（kg·min）] were used for maintenance of anesthesia.At 30 min before the end of operation,infusion of cisatracurium was stopped.At 15 min before the end of operation,infusion of sevoflurane was stopped and remifentanil was reduced to 1/10-1/5 amount until extubation.In group Ⅱ,propofol5-12 mg/（kg·h）]was used for total intravenous anesthesia,which combined with conventional dose cisatracurium0.1-0.2 mg/（kg·h）] and remifentanil0.1~1.0 μg/（kg·min）]for maintenance of anesthesia.At 30 min before the end of operation,infusion of cisatracurium was stopped.The eyelash reflex time,eye opening time,extubation time,the number of cases of intraoperative awareness and restlessness score during anesthetic recovery were recorded.Results There was no significant difference in eyelash reflex time,eye opening time and extubation time between two groups（all in P 0.05）.There was no intraoperative awareness in all patients.The restlessness incidence of group Ⅰ was significantly lower than that of group Ⅱ（P 0.05）.The dosages of cisatracurium and remifentanil in group Ⅰ was signi-ficantly lower than that in group Ⅱ（all in P 0.05）.Conclusion It is demonstrated that both fast track anesthesia（sevoflurane ＋ remifentanil ＋ cisatracurium or propofol ＋ remifentanil ＋ cisatracurium） have good controllability,good safety and quick palinesthesia.And the former method can save more drug consumption and patients in this group enjoyed higher quality of palinesthesia.