瑞芬太尼复合七氟烷或异氟烷麻醉在老年胃癌根治术中的效果比较

目的探讨七氟烷或异氟烷复合瑞芬太尼吸入全身麻醉用于老年胃癌根治术患者的麻醉效果和恢复情况。方法选择择期行胃癌根治术的老年患者62例，美国麻醉医师学会分级Ⅱ、Ⅲ级，按随机数字表法随机分为两组：七氟烷复合瑞芬太尼组（SR组）31例，异氟烷复合瑞芬太尼组（IR组）31例。两组的麻醉诱导用药及方法相同，均于插管后即刻用微量泵连续恒速泵人瑞芬太尼，瑞芬太尼血浆靶浓度为6峭／L，其中sR组气管插管后持续吸入1．5％-2．0％七氟烷，IR组气管插管后持续吸入异氟烷，吸入浓度为1％～2％。术毕前5rain停止吸入七氟烷或异氟烷；缝皮时停止输注瑞芬太尼，术毕前20rain静脉注射芬太尼0．1mg。分别于麻醉诱导前（rID）、麻醉诱导后（T1）、气管插管即刻（他）以及手术开始后5min（T3）、30min（T4）和术毕时（T5）记录收缩压、舒张压、心率等值；记录苏醒时间及拔管时间，并进行拔管后苏醒质量评分（OAAS）。结果两组术中各时点收缩压、舒张压及心率比较差异均无统计学意义（P均〉0．05），SR组苏醒时间、拔管时间显著短于IR组（10．4±3．9）、（16．3±5．8）min，t=6．25，P=0．02；（5．9±3．1）、（9．7±2．5）min，t=4．19，P=0．01]。SR组OAAS显著高于IR组（4．1±1．2）、（2．9±1．0）分，t=3．27，P=0．03]。结论异氟烷或七氟烷复合瑞芬太尼麻醉均可应用于老年胃癌根治术患者。与异氟烷复合瑞芬太尼麻醉比较，七氟烷复合瑞芬太尼麻醉后患者恢复较快，更适合老年患者。

Effect comparison of remifentanil combined with sevoflurane or with isoflurane in elderly patients undergoing radical gastrectomy for cancer

Objective To compare the clinical effects of remifentanil combined with sevoflurane or with isoflurane in elderly patients undergoing radical gastrectomy for cancer and their recovery. Methods Sixty-two patients, who scheduled for radical gastrectomy for cancer was randomly divided into remifentanil combined with sevoflurane group （ SR group, n = 31 ） and remifentanil combined with isoflurane group （ IR group, n = 31 ）. They were classified into American Society of Anesthesiology（ASA） physical status Ⅱ and Ⅲ, The procedure of two Anesthesia was same,in which remifentanil was continually pumped into at the same velocity using micro pump immediately after intubation,till the target density in plasma increased to 6 μg,/L. Sevoflurane at 1.5% to 2.0% was inhaled in the SR group,whereas isoflurane at 1% to 2% in the IR group. The inhalation was ended at 5 mins before the surgery was completed, Remifentanil was stopped while stuturing, and 0. 1 mg of Remifentanil was injected at 20 mins before the surgery was completed. The heart rate（HR） and blood pressure were recorded at before induction of anesthesia （ TO ）, after induction of anesthesia （ T1 ）, immediate intubation （ T2 ）, surgery after the start of 5 min （ T3 ）, 30 min （ T4 ） and the time of surgery （ T5 ）, respectively. The recovery time and extubation time, and quality score for awakening after extubation （OAAS） were also recorded. Results There were no significant differences in HR, SBP and DBP at every time points observed between the two groups. The recovery time（ 10. 4 ± 3.9） mins and extubation time（5.9 ± 3.1 ） min in SR group was significantly shorter than that of（ 16. 3 ± 5.8） rain and （9. 7 ± 2. 5） min in the IR group （t = 6. 25 and 4. 19, P = 0.02 and 0.01, respectively ）. The OAAS after extubation in the two groups gradually increased, and immediately after extubation and extubation after 10 min,OAAS in the SR group was（4. 1± 1.2） ,which was significantly higher than that of （2. 9 ± 1.0） in the IR group （ t = 3.27, P = 0. 03 ）. Conclusion Either stevoflurane-remifentanil or isoflurane remifentanil anesthesia can be used safely in elderly patients undergoing radical gastrectomy for cancer. Anesthesia with Sevoflurane-remifentanil provides better faster recovery than isofluraneremifentanil in elderly patients.