喉罩-瑞芬太尼复合七氟醚或丙泊酚麻醉在经尿道前列腺电切术中的应用

目的比较喉罩-瑞芬太尼复合七氟醚与喉罩-瑞芬太尼复合丙泊酚2种麻醉方法在经尿道前列腺电切术中的优缺点,为前列腺电切术寻求安全、快捷的麻醉方法提供参考。方法40例接受经尿道前列腺电切术患者随机均分为喉罩-瑞芬太尼-七氟醚（S）组与喉罩-瑞芬太尼-丙泊酚（P）组。麻醉诱导采用静注咪唑安定0.03～0.06 mg.kg-1,芬太尼3μg.kg-1,阿曲库胺0.5 mg.kg-1,S组吸入七氟醚0.5%～3%,P组静注丙泊酚0.5～1 mg.kg-1,待下颌松弛置入喉罩后,S组静脉泵入瑞芬太尼0.15μg·kg-1·min-1及吸入七氟醚0.5%～3%维持麻醉,P组则泵入瑞芬太尼0.15μg.kg-1.min-1及丙泊酚3～8 mg.kg-1.h-1维持麻醉。记录患者术中生命体征、苏醒时间、术中及术后并发症发生情况。结果麻醉诱导后2组患者平均动脉压（MAP）及心率（HR）均明显低于麻醉前水平（P〈0.05）,S组MAP、HR在手术开始前已基本恢复到诱导前水平,而P组术中各个时间点MAP及HR仍明显低于诱导前,且较S组麻醉前水平及对应时间点水平低（P〈0.05）。结论喉罩-瑞芬太尼复合七氟醚或喉罩-瑞芬太尼复合丙泊酚麻醉用于经尿道前列腺电切术都能提供满意的麻醉,七氟烷比丙泊酚可控性更佳,术中血流动力学更稳定,术后苏醒更为迅速,是一种较理想的麻醉方法。

Laryngeal mask airway-composites remifentanil and sevoflurane or propofol anesthesia in the perioperation of the transurethral resection of the prostate

Objective To compare the advantages and disadvantages of sevoflurane-remifentanil anaesthesia with propofol-remifentanil anaesthesia with laryngeal mask airway(LMA) in the perioperation of the transurethral resection of the prostate.Methods Forty patients, classified from ASA Ⅰ to III grade and scheduled for general anesthesia for the perioperation of the transurethral resection of the prostate, were randomly divided into sevoflurane-remifentanil anaesthesia group(group S,n=20) and propofol-remifentanil anaesthesia group(group P,n=20) . Anaesthesia was induced with a bolus of midazolam(0.03～0.06 mg·kg-1), fentynal (3 μg·kg-1),atracurion(0.5 mg·kg-1)and sevoflurane(0.5%～3%) in group S or an infusion of propofol(0.5～1 mg·kg-1) in group P. Laryngeal mask airway (LMA) was used for airway maintenance after inducing of anaesthesia. Anesthesia was maintained through pumping remifentanil(0.15 μg·kg-1·min-1).At the same time, group S were given sevoflurane(0.5%～3%)and group P were given infusion of propofol (3～8 mg·kg-1·h-1).Heart rate was monitored and emergence time and complications were recorded.Results MAP and Heart rate were all decreased after anesthesia induction compared with those of before in both groups(P<0.05),which recovered to the base lines before skin incision in group S, but not in group P.Conclusion Under LMA ventilation, remifentanil combined with sevoflurane inhalation results in more stable hemodynamics and smoother anesthesia than propofol-remifentanil anaesthesia.