三种全身麻醉方法对患者麻醉苏醒期质量的影响

目的观察3种全身麻醉方法对患者麻醉苏醒期质量的影响。方法2013年1月选择66例美国麻醉医师协会分级Ⅰ-Ⅱ级，年龄40～60岁，体质量45～70kg，择期拟在全身麻醉下行胃肠、肝胆、乳腺、甲状腺或妇科手术患者，随机均分为S组（七氟烷联合瑞芬太尼组）、P组（异丙酚联合瑞芬太尼组）及SP组（七氟烷、异丙酚联合瑞芬太尼组）各22例。三组患者均以脑电双频指数值等于60为时间起点记录此刻至患者睁眼及拔管的时间：用激越严重性量表（OAAS）对患者进行苏醒质量评分：观察并记录患者苏醒时的并发症如术后恶心呕吐（PONV）、苏醒期躁动（EA）、嗜睡等发生情况。结果SP组患者睁眼及拔管时间均较S、P组长，差异有统计学意义（P〈0．05）；S、P组OAAS评分在睁眼时及拔管时较SP组高，但三组各时点0AAS评分比较，差异均无统计学意义（P〉0．05）；S组EA及PONV发生率较P、SP组明显增高：而P组术后嗜睡发生率较S、SP组明显增高，差异均有统计学意义（P〈0．05）；P组有1例患者发生术中知晓，但三组术中知晓发生率比较，差异无统计学意义（P〉0．05）。结论七氟烷、异丙酚联合瑞芬太尼维持麻醉患者EA、PONV、术后嗜睡较单独使用七氟烷或异丙酚发生更少，患者麻醉苏醒期质量更高。

Influence of three general anesthesia on the quality of patients during anesthesia recovery period

Objective To investigate the effect of three general anesthesia methods on the quality of patients during anesthesia recovery period. Methods 66 patients with gastrointestinal surgery, hepatic surgery, thyroid surgery or gynecological surgery under general anesthesia aged from 40 to 60 with the weight of 45 kg-70 kg, according to American Society of Anesthesi ologists（ASA） scale（grade I to grage Ⅱ） ,were enrolled and randomized into group S（sevoflurane with remifentanil group） ,group P （propofol with remifentanil group） and group SP （sevoflurance with propofol and remifentanil）, 22 cases in each group. To observe the duration from bispectral index（BIS） equaled to 60 until analepsia and the vital signs ,the duration until extubation and the vi- tal signs. The quality of patients in the awaking stage were compared by the OAAS scales among the three groups. To observe and record the anesthesia complications such as the postoperative nausea and vomiting （PONV）, emergence agitation （EA）, lethargy and so on. Results The durations of extubation and recovery of anaesthesia were longer in the group SP than those in group S and group P with statistically significant difference （P〈0.05） ; and the OAAS scores at different time-point in the group SP were lower than those in the group S and P,but comparison of OAAS score at different points in the three groups had no statistical difference （P〉0.05）. Besides, group S showed higher incidence rate of the emergence agitation （EA） and PONV compared with the group S and SP with statistically significant difference（P〈0.05 ）. Group P showed higher incidence rate of lethargy compared with the group S and SP with statistically significant difference （P〈0.05）. One of the patients in group P suffered intraoperative awareness, but as for the incidence rate of intraoperative awareness, the three groups showed no statistical difference （P〉0：05）. Conclusion The ＂sandwich＂ anesthesia method--sevoflurane combined with propofol and remifentanil can reduce incidence rate of the EA, PONV and lethargy,which has a better waking quality of patients during anesthesia recovery period than sevoflurane anaesthesia and propofol anaesthesia.