手术结束前应用地氟醚替换异氟醚对麻醉苏醒及花费的影响

目的 探讨手术结束前30 min应用地氟醚替换异氟醚对患者麻醉苏醒的影响。方法 选取2016年4月~2017年4月择期妇科腹腔镜手术患者90例，ASAⅠ~Ⅱ级，随机分为D组（地氟醚）、I组（异氟醚）和I+D组（异氟醚+地氟醚）三组，每组30例。全麻诱导均为咪达唑仑0.03 mg/kg，舒芬太尼0.3 μg/kg，异丙酚2 mg/kg，顺式阿曲库铵0.15 mg/kg。麻醉维持:D组开启地氟醚挥发罐至6%；I组开启异氟醚挥发罐至1.6%；I+D组开启异氟醚挥发罐至1.6%，手术结束前30 min关闭异氟醚，同时开启地氟醚挥发罐至6%，三组均复合瑞芬太尼0.1~1 μg/（kg·min）维持麻醉。手术结束停用所有麻醉药，观察呼吸恢复时间、苏醒时间、拔除喉罩时间、苏醒期躁动评分和术中知晓，计算三组用药量及花费。结果 D组和I+D组的呼吸恢复时间、苏醒时间、拔除喉罩时间均比I组缩短，差异有统计学意义（P＜0.05）；两两比较:D组和I+D组间差异无统计学意义（P＞0.05），其余两两比较结果均有统计学意义（P＜0.05）。三组间苏醒期躁动评分差异无统计学意义（P＞0.05）。I+D组麻醉药花费较D组减少，差异有统计学意义（P＜0.05）。结论 手术结束前应用地氟醚替换异氟醚可加快患者麻醉苏醒且花费相对较低。

The Effect of Desflurane Replacement with Isoflurane on the Recovery and Cost of Anesthesia before End of Surgery

Abstract:Objective To investigate the effect of using desflurane to replace isoflurane 30 min before operation on anaesthesia recovery of patients.Methods Select April 2016 to April 2017 90 patients undergoing elective gynecological laparoscopic surgery, ASA I ~ II,were randomly divided into D group(Sevoflurane),I group(Isoflurane)and I + D group(isoflurane+desflurane)three groups,30 cases in each group.The induction of general anesthesia was midazolam 0.03 mg/kg,sufentanil 0.3 μg/kg, propofol 2 mg/kg,cis atracurium 0.15 mg/kg.Maintenance of anesthesia: group D desflurane vaporizer to open 6%;I group open to 1.6% isoflurane vaporizer; group I+D isoflurane vaporizer open to 1.6%,before the end of surgery 30 min closed isoflurane,desflurane vaporizer to 6% open at the same time,the three groups were combined with remifentanil 0.1~μg/（kg·min）to maintain anesthesia.All anesthetics were discontinued at the end of operation.Respiratory recovery time,recovery time,laryngeal mask airway time, recovery time agitation score and intraoperative awareness were observed.The dosage and cost of the three groups were calculated.Results D group and I+D group the breathing recovery time,recovery time,removal of the laryngeal mask were shorter than group I,the difference was statistically significant(P<0.05);Comparison between the two groups:There was no significant difference between group D and group I+D(P>0.05), and the other two groups were statistically significant(P<0.05).There was no significant difference in agitation scores between the three groups(P>0.05).The cost of anesthetics in the I+D group was lower than that in the D group,and the difference was statistically significant(P<0.05).Conclusion The replacement of isoflurane with desflurane before the end of surgery can speed up the recovery of anesthesia and cost relatively less.