不同年龄患者在同一麻醉深度下呼气末七氟烷浓度的比较

摘要

Objective:To investigate the difference of the end-expired concentrations of sevoflurane in patients with different ages undergoing general surgery with remifentanil .Methods: One hundred and twenty-five ASAⅠ-Ⅱpatients undergoing general surgery were allocated into 5 groups ( 25 cases in each group ) , group 1:1-4 yrs;group 2:5-18 yrs;group 3:19-40 yrs;group 4:41-65 yrs;and group 5:66-86 yrs.After inducing ,anesthesia was maintained with sevoflurane and remifentanil ( 0.1 μg · kg -1 · min-1 ) .The concentration of sevoflurane was adjusted to maintain Narcotrend index (NI) at 64.BP,HR and expired concentration of sevoflurane were measured and recorded at these three time points:before anesthesia , the time when NI maintaining 64 and 85.Results:There were no recovering delay ,respiration dysfunction or intraoperative awareness in each group .The values of end-expired concentration of sevoflurane among the 5 groups had significant differences ( P <0.05 ) .At the same anesthesia depth, the value of end-expired concentration of sevoflurane in group 3 was lowest among the 5 groups.Conclusion:The end-expired concentrations of sevoflurane in different ages at the same anesthesia depth undergoing general surgery with remifentanil were significantly different (P<0.05).And the end-expired concentration of sevoflurane should be adjusted according to the age of the patient for the proper depth of sevoflurane anesthesia .%目的：观察不同年龄的全麻普通外科手术患者复合雷米芬太尼麻醉在同一麻醉深度下呼气末七氟烷浓度的区别。方法：125例行腹部手术的患者， ASA分级Ⅰ～Ⅱ，按年龄分为5组：组1为1～4岁，组2为5～18岁，组3为19～40岁，组4为41～65岁，组5为66～86岁，每组25例。静脉诱导后雷米芬太尼维持输注速度为0.1μg · kg -1· min-1和吸入七氟烷维持麻醉，调节七氟烷浓度使Narcotrend指数（ Narcotrend index，NI）值稳定在64水平。手术结束后关闭七氟烷挥发罐，NI值逐步回升至85水平。记录术前、NI＝64、NI＝85时点的血压、心率、呼气末七氟烷浓度，对5组患者的生命体征及呼气末七氟烷浓度进行比较。结果：5组患者各项生命体征平稳，在同一麻醉深度下呼气末七氟烷浓度差异具有统计学意义（ P＜0.05）。组3在同一麻醉深度下，呼气末七氟烷浓度最低（ P＜0.05）。术后患者无苏醒延迟和呼吸功能异常，术后随访所有病例均无术中知晓。结论：不同年龄的全麻普通外科手术患者复合雷米芬太尼麻醉在同一麻醉深度下呼气末七氟烷浓度的差异有统计学意义，临床麻醉中要根据患者的年龄选择合适的七氟烷浓度。