七氟醚在脊柱矫形术麻醉中的临床应用

目的评价七氟醚对脊柱矫形术中唤醒试验的影响，观察听觉诱发电位（AEP）监测在唤醒试验中的作用。方法择期行脊柱矫形术患者22例，ASAI～Ⅱ级，年龄12～18岁，随机分为：七氟醚瑞芬太尼丙泊酚组（SRP）和异氟醚瑞芬太尼丙泊酚组（IRP），每组11例。SRP组、IRP组分别吸入低流量七氟醚或异氟醚，术中均微泵输注瑞芬太尼及丙泊酚维持麻醉。唤醒试验成功后，所有麻醉药恢复原来的速度。两组麻醉前行AEP监测，术中以MAP、HR、AAI值调整七氟醚或异氟醚浓度。记录麻醉前、术中唤醒前停醚时、唤醒时、唤醒后10min及术毕清醒拔管时各时间点呼气末七氟醚浓度（ETsev）、呼气末异氟醚浓度（ETiso）及MAP、HR，AAI值。术后1天随访。结果所有患者均成功实施唤醒试验，唤醒期间有1例呛咳，术后随访对其他事件无回忆。与IRP组相比，SRP组唤醒时间缩短。AEP能比较准确预测唤醒时间，对唤醒试验有指导意义。结论与异氟醚相比，七氟醚更适用于脊柱矫形术，AEP监测对唤醒试验有指导作用，可以缩短唤醒时间，防止脊髓长时间缺血有一定意义。

Effect of sevoflurane-remifentanil-propofol on scoliosis surgery

Objective To evaluate the effect of sevoflurane-remifentanil-propofol on scoliosis surgery. Methods Twenty-two ASA Ⅰ or Ⅱ patients with scollosis surgery were randomly divided into 2 groups, including sevoflurane- remifentanil-propofol group {SRP） and isoflurane-remifentanil-propofol group （IRP）. Anesthesia was maintained with low-flow （1L/min） inhalation of sevoflurane or isoflurane and nitrous oxide in oxygen. The infusion of remifentanil was immediately reduced to 0.1 -0.15 μg· kg-1 min-1 and propofol inhalation anesthetic were stopped before wake-up. All of the anesthetic were maintained the previous rate after wake-up. The end-tidal concentration of sevoflurane, isoflurane and hemodynamic variables including MAP and HAR, and Bis after anesthesia, postoperative recovery time were recor- ded. Result All patients could not recall the wake-up test and other intraoperative events. Only 1 agitation was observed and all patient wiggled their toe as instructed during the wake-up test. The SRP combined with IRP inhalation can short- en the intraoperative wake-up （P~0.01）. Conclusion The SRP treated with AEP and IRP inhalation can shorten the in- traoperative wake-up time, and is an appropriate anesthetic technique for scoliosis surgery.