靶控呼出不同浓度七氟烷复合舒芬太尼麻醉效果比较

摘要

Objective To compare the anesthetic effects of different concentrations of sevoflurane combined with sufentanil by target controlled exhalation in senile patients to receive hip joint replacement.Methods A total of 80 senile patients to receive unilateral hip joint replacement were selected and randomly divided into four groups.The concentration of the sevoflurane (CetSEV) by target controlled exhalation in group A was 1.3 MAC and that of compound sufentanil was 0.2 μg/(kg·h);the CetSEV in group B was 1.0 MAC and that of compound sufentanil was 0.3 μμg/(kg ·h);the CetSEV in group C was 0.7 MAC and that of compound sufentanil was 0.4 μg/(kg·h);the CetSEV in group D was 0.5 MAC and that of compound sufentanil was 0.5 μg/(kg·h).The mean arterial pressure (MAP) and heart rate (HR) before anesthesia (T1),upon skin incision (T2),upon tracheal extubation (T3),upon return to the ward from the postanesthesia care unit (PACU) (T4) and on the first day after the operation (T5) among the four groups were compared.The visual analogy scores (VAS) upon tracheal extubation (VAS1),return from PACU to the ward (VAS2) and on the first day after the operation (VAS3) and the amount of vasoactive agent and the amount of muscle relaxant during operation,the recovery time,the incidence of postoperative delirium and the postoperative length of day (LOS) among the four groups were compared.Results The MAPs in group D at T3,T4 and T5 were higher than those in the other three groups (P ＜ 0.01);the VAS scores at VAS2 in group D were lower than those in the other three groups (P ＜ 0.05);the recovery time in group C was the shortest (P ＜ 0.01);the postoperative LOS (P ＜ 0.05) and the amount of muscle relaxant (P ＜ 0.01) in group D were longer and more than those in the other three groups;the incidence of postoperative delirium in group A was significantly higher than that in the other three groups(P ＜ 0.01).Conclusion The application of 0.7 MAC sevoflurane combined with 0.4 μg/(kg-h) sufentanil in hip joint replacement among senile patients ensures reliable depth of anesthesia,rapid and complete postoperative recovery and stable perioperative hemodynamics,so it is worthy of popularization and application.%目的 比较老年髋关节置换术患者靶控呼出不同浓度七氟烷复合不同剂量舒芬太尼的麻醉效果.方法 选择80例拟行单侧髋关节置换手术的老年患者,随机分为4组.A组靶控呼出七氟烷浓度(CetSEV)为1.3 MAC,复合舒芬太尼0.2 μg/(kg·h);B组靶控CetSEV为1.0 MAC,复合舒芬太尼0.3 μg/(kg· h);C组靶控CetSEV为0.7 MAC,复合舒芬太尼0.4 μg/(kg,h);D组靶控CetSEV为0.5 MAC,复合舒芬太尼0.5 μg/(kg·h).比较4组麻醉前(T1)、切皮时(T2)、气管拔管时(T3)、从麻醉后恢复室(PACU)返回病房时(T4)、术后第1 d(T5)的平均动脉压(MAP)、心率(HR).比较4组的气管拔管时(VAS1)、从PACU返回病房时(VAS2)、术后第1 d(VAS3)的疼痛(VAS)评分以及4组的术中血管活性药物用量、肌松药用量、术后苏醒时间、术后谵妄发生率、术后住院天数等.结果 D组T3、T4、T5的MAP均高于其他3组(P＜0.01);D组VAS2时VAS评分低于其他3组(P＜0.05);C组的苏醒时间最短(P＜0.01);D组的术后住院天数(P＜0.05)和肌松药用量(P＜0.01)也大于其他3组;A组术后谵妄发生率明显高于其他3组(P＜0.01).结论 在老年患者髋关节置换术中,采用靶控呼出0.7 MAC七氟烷复合舒芬太尼0.4 μg/(kg·h)维持麻醉,麻醉深度确实可靠,术后苏醒迅速完全,围术期血流动力学稳定,值得推广应用.