瑞芬太尼复合丙泊酚或七氟烷全麻维持效果的比较

目的观察比较瑞芬太尼复合丙泊酚或七氟烷两种麻醉维持方式在全身麻醉手术中的应用效果。方法择期全麻手术患者40例,随机分成瑞芬太尼复合丙泊酚麻醉组（P组）和瑞芬太尼复合七氟烷麻醉组（S组）。P组术中以瑞芬太尼0.1～0.2μg/（kg.min）与丙泊酚4～6mg/（kg.h）微量泵持续静脉输注维持麻醉,S组术中则以瑞芬太尼0.1～0.2μg/（kg.min）微量泵持续静脉输注和2%～4%七氟烷持续吸入维持麻醉,术中通过麻醉意识深度指数CSI（cerebral state index）监测调控维持麻醉深度在45±5。记录入室稳定15min时（T0）、麻醉诱导时（T1）、气管插管后（T2）、切皮时（T3）、手术进行30min时（T4）、手术刺激最强时（T5）、拔管（T6）和出手术室时（T7）的HR、SBP、DBP和SpO2,停止麻醉至拔管的时间、拔管时的清醒程度和术后并发症情况。结果两组间HR、SBP、DBP、SpO2比较,差异无统计学意义,手术时间和术后并发症比较,差异无统计学意义,拔管时间及拔管时清醒程度两组间比较差异有统计学意义（P〈0.05）。结论瑞芬太尼复合丙泊酚或七氟烷两种麻醉方式用于全麻手术维持,麻醉效果满意，血流动力学稳定，苏醒快速，尤以瑞芬太尼复合七氟烷麻醉方式更佳，术后并发症发生率低，具有可控性强、安全有效的特点。

Comparison of Propofol/Remifentanil and Sevoflurane/Remifentanil for Maintenance of Anaesthesia

Objective To compare the effects and safety of propofol/remifentanil and sevoflurane/remifentanil for maintenance of anaesthesia.Methods Forty patients undergoing selective general anesthesia operation were randomly divided into two groups and all received remifentanil 0.1 to 0.2 μg/（kg·min） followed by continuous venous infusion.Anaesthesia was maintained with a continuous infusion of propofol 4～6 mg/（kg·h） in group P（n=20）,while with continuous inspiration of sevoflurane,initial concentration at end-tidal concentration 2% to 4% in group S（n=20）.CSI（cerebral state index） was used in operation to keep the depth of anesthesia at level of 45±5.The HR,SBP,DBP and SpO2 was recorted at the time point of fifteen minutes after the patients got into the operating room（T0）,induced anesthesia（T1）,after intubation（T2）,incision（T3）,thirty minutes after incision（T4）,the strongest stimulus of the operation（T5）,before extubation（T6）,leaving the operating（T7） respectively.The duration before extubation,degree of awakeness and operational complications were observed.Results There was no significant difference in HR,SBP,DBP,SpO2,duration of operation,and complications between the two groups（P0.05）.The difference in the duration before extubation,degree of awakeness had statistical significance（P0.05）.Conclusion Propofol/remifentanil and especially sevoflurane/remifentanil provided satisfactory effects for maintenance of general anaesthesia with a stable hemodynamics indexes,high controllability and safety,lower rate of complications,and short time of awakeness.