七氟烷诱导维持麻醉在甲状腺切除手术中的应用研究

目的 观察七氟烷诱导维持麻醉在甲状腺部分切除术中的应用，探讨七氟烷诱导维持麻醉在成人短小手术中应用的安全性和有效性。 方法 选择择期行甲状腺部分切除术ASA分级Ⅰ～Ⅱ级的患者47例，七氟烷高流量吸入复合舒芬太尼、顺式阿曲库铵进行麻醉诱导，七氟烷复合舒芬维持麻醉。记录意识消失时间、诱导时间、苏醒时间及拔管时间；记录血流动力学变化及血管活性药物使用情况；随访术中知晓、术后恶心呕吐发生情况。 结果 最终45例患者顺利完成实验，意识消失时间为(55.76±14.02) s，诱导时间为(2.82±0.33) min，苏醒时间为(2.08±0.76) min，拔除喉罩时间为(5.50±1.06) min。麻醉期间各时点血液动力学变化:插管后5 min时收缩压、舒张压和心率较诱导前显著降低(P＜0.05)，拔管即刻心率较诱导前显著增加(P＜0.05),而血压较诱导前增加，但差异无统计学意义(P＞0.05)。插管即刻，切皮时的血压、心率与诱导前差异无统计学意义(P＞0.05)。2例患者需要使用血管活性药物。术后24 h随访:恶心呕吐:0级:20例(44.4%)，1级16例(35.6%)，2级9例(20%)，2例(4.4%)需使用止吐药干预。所有患者均在术后第2～3天出院。 结论 七氟烷全程吸入麻醉过程平稳，苏醒迅速，可满足甲状腺部分切除术的麻醉需求，仍然需要更多的研究探讨七氟烷诱导维持麻醉在成人中的应用。 

Sevoflurane for induction and maintenance of anesthesia in thyroidectomy

Objective To observe the efficacy of sevoflurane for the induction and maintenance of anesthesia in thyroidectomy,and discuss the safety and effectiveness of solely inhaled sevoflurane in minor surgery for adults. Methods A total of 47 patients undergoing elective thyroidectomy,with ASA physical status Ⅰ- Ⅱ,were enrolled into this study. The induction of anesthesia was performed in all patients with high-flow sevoflurane inhalation combined with sufentanil and cisatracurium,and the anesthesia was maintained with sevoflurane and sufentanil. The time to the transient loss of consciousness,time for the induction of anesthesia,time to recovery of consciousness and removal of laryngeal mask airway were recorded,and the intraoperative haemodynamics and use of vasoactive drugs were observed. The intraoperative awareness and incidence of postoperative nausea and vomiting were followed up. Results The 45 in 47 patients underwent successfully the surgery without using vasoactive substances. The time to the transient loss of consciousness was(55. 76 ±14. 02)s,time for the induction of anesthesia was(2. 82 ±0. 33) min,time to recovery of consciousness was(2. 08 ±0. 76)min,and time to removal of laryngeal mask airway was(5. 50 ±1. 06) min. The changes of hemodynamics in different time point:the systolic pressure,diastolic pressure and heart rate in 5 min after intubation was significantly lower than baseline blood pressure(BBP) and baseline heart rate(BHR) index(P < 0. 05). HR increased significantly at the removal of laryngeal mask airway as compared with BHR(P < 0. 05),however,BP increased not obviously(P > 0. 05). There was no significant change in HR and BP during the induction and skin incision(P > 0. 05). The follow up at 24 h after the operation showed that the incidence of postoperative nausea and vomiting of level 0 was 44. 4%(20 cases),of level 1 was35. 6%(16 cases),of level 2 was 20%(9 cases). The antiemetic was administrated in 2 cases(4. 4%). All patients were discharged in 2 to 3 days after the operation. Conclusion The stable anesthesia state can be achieved by using sevoflurane for the induction and maintenance of anesthesia in thyroidectomy,with the advantage of less time for recovery of consciousness. However,more experiments should be carried to explore the application of sevoflurane in the induction and maintenance of anesthesia in adults.