不同麻醉方法用于鼻内镜手术患者麻醉效果比较

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摘要目的：比较异丙酚/瑞芬太尼静脉麻醉与七氟烷吸入全身麻醉在鼻内镜手术患者中的应用效果。方法：随机选择ASA I-II级的鼻内镜手术患者40例，分成2组，即异丙酚/瑞芬太尼静脉维持麻醉组（T组）和七氟烷吸入维持麻醉组（S组），2组均采用静脉诱导。T组气管插管后微量注射泵静脉输注异丙酚、瑞芬太尼维持麻醉，S组气管插管后吸入七氟烷维持麻醉，使脑电双频指数（BIS）在45～60之间。记录入室后（T0）、诱导后（T1）、插管后1 min（T2）、插管后3 min（T3）、拔管后1 min（T4）、拔管后3 min（T5）的平均动脉压（MAP）、心率（HR）、氧饱和度（SpO2）和BIS值，记录苏醒时间、拔管时间、术中降压药使用频率以及术后躁动、恶心呕吐、过度镇静等不良反应发生例数。结果：与S组比较，T组MAP在T3时较低（P＜0.05），SpO2在T5时较低（P＜0.05）。与T0时比较，S组MAP在T1～T3时降低，T4时升高（P＜0.05），HR在T4时加快（P＜0.05），SpO2在T1～T3时增加（P＜0.05）；T组MAP在T1～T3时降低（P＜0.05），HR在T3时减慢（P＜0.05），SpO2在T1～T3 时增加，在T5降低（P＜0.05）。与S组比较，T组苏醒时间短（P＜0.05），Ramsay镇静评分高（P＜0.05），苏醒期躁动发生率低（P＜0.05），术中需额外降压药行控制性降压例数较少（P＜0.05）。结论：鼻内镜手术采用异丙酚/瑞芬太尼静脉麻醉与采用七氟烷吸入麻醉比较，围术期血压控制稳定，苏醒快，躁动发生率低。

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关键词 ：全凭静脉麻醉, 瑞芬太尼, 异丙酚, 吸入麻醉, 七氟烷, 鼻内镜手术

Abstract：Objective: To compare the effect of total intravenous anesthesia with sevoflurane inhalation anesthesia in endoscopic sinus surgery. Methods: Forty patients of ASA I and II undergone selective endoscopic sinus surgery were randomly divided into two groups: group T (remifentanyl 5～10 μg/kg/h and propofol 4～8 mg/kg/h maintenance anesthesia), group S (sevoflurane 0.8～1.0 MAC maintenance anesthesia), and induced by intravenous in both groups. The fluctuation of the BIS values should be controlled between 45 and 60 during the surgery. Hemodynanmic parameters including MAP, HR, and SpO2 were recorded continuously, especially before induction (T0), after induction before intubation (T1), 1 minute after intubation (T2), 3 minutes after intubation (T3), 1 minute after extubation (T4), and 3 minutes after extubation (T5). Operation time, recovery time, extubation time, the case of using hypotensive drugs during perioperation and the incidence of side effects after postoperation such as dysphoria, PONV, severe sedation were also recorded. Results: Compared with group S, the MAP at T3 and the SpO2 at T5 were declined in group T (P<0.05). Compared with T0, the MAP at T1～T3 were lower and at T4 was risen in group S (P<0.05), the HR at T4 was accelerated in group S (P<0.05). The MAP at T1～T3 was lower in group T (P<0.05), and the HR at T3 was slower in group T (P<0.05), the SpO2 at T1～T3 was risen and T5 was lower in group T (P<0.05). Compared with S group, the recovery time in group T was shorter (P<0.05), the incidence of emergence agitation in group T was lower (P<0.05), and the Ramsay sedation score in group T was higher (P<0.05), the cases of patients need controlled hypotension were less (P<0.05). Conclusion: The anesthesia effectiveness of propofol/remifentanyl intravenous anesthesia is more suitable and safer for endoscopic sinus surgery than sevoflurane inhaled maintenance anesthesia, the MAP is easier to adjust for the satisfaction of requirement of operation, revival time is faster, but incidence of agitation is loss.

Key words： total intravenous anesthesia remifentanyl propofol inhalation anesthesia sevoflurane endoscopic sinus surgery

收稿日期: 2014-04-04

作者简介: 金建国（1966-），男，浙江椒江人，主治医师。

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https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I2/139

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