地氟醚、七氟醚与安氟醚低流量麻醉临床观察.doc

???? 地氟醚、七氟醚与安氟醚低流量麻醉临床观察 ???? ????　摘要　目的：比较地氟醚、七氟醚、安氟醚用于低流量麻醉时BP和HR改变、苏醒过程、不良反应以及药物费用。方法：42例ASAⅠ～Ⅱ级择期腹部外科手术病人随机分成地氟醚、安氟醚和七氟醚三组。麻醉诱导后连接Cicero麻醉机，降低新鲜气流，地氟醚和安氟醚为0.3～0.5L／min，七氟醚为0.8～1.0L／min，从回路呼出端向麻醉机回路内注入液态吸入麻醉药，4～5分钟内使三组病人呼气末麻醉药浓度达到1MAC左右，即地氟醚浓度7％、七氟醚浓度1.9％和安氟醚浓度1.7％左右，然后维持。用DetaxAS／3监测仪监测ECG、SpO2、BP、PETCO2及吸入麻醉药浓度。手术结束观察病人苏醒时间，术后随访术中知晓、恶心呕吐及记忆恢复时间，计算麻醉药用量及价格。结果：三组病人气管插管时MAP和HR均显著增加。手术开始，地氟醚组MAP和HR升高最显著。术毕，地氟醚组、七氟醚组和安氟醚组意识恢复时间分别为6.2±2.0分钟、14.8±3.4分钟和29.2±6.5分钟。术后恶心呕吐发生率七氟醚组最低（14％）。麻醉30分钟内地氟醚组用量大于七氟醚组和安氟醚组，60分钟后三组病人吸入全麻药用量相近。结论：1MAC吸入麻醉药并不能完全解除手术所引起的BP和HR反应，地氟醚组苏醒最快，术后恶心呕吐发生率七氟醚组最低。　　关键词　　地氟醚　七氟醚　安氟醚　全身麻醉 Clinical Observation of Desflurane，Sevoflurane and Enflurane in Low Flow Anesthesia Zhang YanYin，Xue ZhangGang，Jiang HaoDepartment of Anesthesiology，Zhongshan Hospital，Shanghai Medical University，Shanghai 200032 　　Abstract　Objective：To compare the changes of blood pressure and heart rate，emergence process，adverse efferts and cost among desflurane，sevoflurane and enflurane in low-flow anesthesia．Methods：Forty-two ASAⅠ～Ⅱ patients were randomly divided into to three groups：sevoflurane（group S，n＝14），desflurane（group D，n＝14） and enflurane（group E，n＝14）．Anesthesia was induced with intravenous thiopental 5 mg／kg and maintained with fresh gas flow 0.3～0.5L／min for desflurane and enflurane，and 0.8～1.0L／min for sevoflurane．7％ end-tidal desflurane in oxygen，1.9％ for sevoflurane and 1.7％ for endoflurane were obtained within 4～5 min by injection liquid anesthetic to the expiratory limb of anesthesia circuit．During the operation，end-tidal expired anesthetic concentration was maintained at 1MAC and cardiovascular responses，emergence profile and recovery characteristics were investigated．Results：compared with their baselines，BP and HR significantly elevated in all of three groups at tracheal intubation，thereafter gradually lowered to the baseline within 4min．BP and HR increased heaviest in group D at the time of incision．The emergence time after discontinuation of desflurane