丙泊酚或七氟醚喉罩麻醉下行宫腔镜手术的有效性和安全性研究  

Efficacy and safety of hysteroscopic surgery under propofol or sevoflurane anesthesia with laryngeal mask airway

作　　者：罗超[1] 刘晓鹏[1] 孙亚楠 杨蓓[2] 伍佳 权哲峰[1] Luo Chao;Liu Xiaopeng;Sun Ya'nan;Yang Bei;Wu Jia;Quang Zhefeng(Department of Anesthesiology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院麻醉科,100069 [2]首都医科大学附属北京安贞医院麻醉中心,100069 [3]恩施市中心医院妇产科

出　　处：《北京医学》2020年第10期944-947,共4页Beijing Medical Journal

摘　　要：目的探讨丙泊酚和七氟醚在喉罩(laryngeal mask airway,LMA)声门上插管手术麻醉中应用时的有效性和安全性。方法选取2019年1~9月首都医科大学附属北京佑安医院择期行宫腔镜手术患者78例,0.5μg/kg瑞芬太尼、2 mg/kg丙泊酚静脉麻醉诱导后置入LMA,患者随机均分并接受丙泊酚或七氟醚麻醉维持。记录口述出生日期时间,根据指令睁眼、握手时间,喉罩拔除时间,Aldrete评分,Aldrete>9分需要时间,并计算恢复指数(recovery index,RI)。记录术中及恢复期咳嗽、喉痉挛及其他并发症发生情况。结果七氟醚组口述出生日期的时间明显短于丙泊酚组[(7.7±4.1)min比(9.6±4.9)min,P<0.01];根据指令睁眼时间、握手时间[(7.1±4.9)min比(9.5±5.1)min],LMA拔除时间[(6.8±3.2)min比(9.1±4.1)min)]、Aldrete>9分需要时间[(10.1±5.8)min比(11.8±6.7)min]七氟醚组均短于丙泊酚组(P<0.05);拔管后5 min的Aldrete评分(9.1±0.6比8.3±0.8)及RI(0.6±0.3比0.7±0.6),七氟醚组亦优于丙泊酚组(P<0.05)。两组咳嗽、喉痉挛等并发症比较,差异无统计学意义(P>0.05)。结论瑞芬太尼镇痛联合丙泊酚或七氟醚行宫腔镜手术喉罩麻醉时,七氟醚麻醉患者恢复更快,且不增加术中及术后并发症的发生率。Objective To investigate the efficacy and safety of propofol and sevoflurane in laryngeal mask airway(LMA)supraglottic intubation surgery anesthesia.Methods A randomized controlled study was conducted in 80 patients scheduled for elective hysteroscopic surgery under general anesthesia with LMA.Subjects were randomly divided into propofol group and sevoflurane group.General anesthesia induction was given 0.5μg/kg remifentanil,followed by intravenous injection of propofol 2 mg/kg.At the end point of induction,the LMA insertion was attempted.According to the assigned intervention group,patients were randomly given propofol or sevoflurane anesthesia for maintenance respectively.This study was powered for the primary outcome‘time to state date of birth’and the secondary outcome‘RI’‘time to respond to the command’and complications were also assessed on the day of surgery.Results Seventy-eight patients were included in the study.The sevoflurane group had the fastest recovery.The mean time to state date of birth in sevoflurane group was significantly shorter than that in propofol group[(7.7±4.1)min vs.(9.6±4.9)min,P<0.01].Other recovery indicators were better than propofol group also(P<0.05).There was no significant difference in cough,oropharynx injury and laryngspasm airway complications between the two groups(P>0.05).Conclusions When using remifentanil infusion for intraoperative analgesia in association with LMA,sevoflurane is associated with a significantly faster recovery and noninferiority in the incidence of intraoperative and postoperative complication than propofol.

关 键 词：喉罩 丙泊酚 七氟醚 宫腔镜 并发症 

分 类 号：R614[医药卫生—麻醉学]