不同七氟醚挥发罐起始浓度设定在中流量静吸复合麻醉中的应用  

Application of different sevoflurane vaporizer initial concentration settings in middle-flow combined intravenousinhalation anesthesia

作　　者：王浩然 王迪 曹汉忠[1] 王玲燕 WANG Hao-ran;WANG Di;CAO Han-zhong;WANG Ling-yan(Department of Anesthesiology,Tumor Hospital Affiliated to Nantong University,Nantong 226300,Jiangsu,China)

机构地区：[1]南通大学附属肿瘤医院麻醉科,南通226300

出　　处：《中国临床医学》2023年第2期330-334,共5页Chinese Journal of Clinical Medicine

摘　　要：目的探讨静吸复合麻醉中,不同七氟醚挥发罐起始浓度(Fd)设定对吸入麻醉药“洗入”时间及麻醉深度的影响。方法选择2020年2月至2022年5月南通市肿瘤医院行盆、腹腔手术的患者80例,均采用静吸复合麻醉。依据不同Fd,将患者随机分为高浓度组(H组,n=40)和低浓度组(L组,n=40)。静脉麻醉诱导后,开启七氟醚挥发罐,调节新鲜气体流量(fresh gas flow,FGF)为2 L/min,根据不同年龄下的最低肺泡有效浓度(minimum alveolar concentration,MAC),分别将H组和L组Fd调节至3 MAC和2 MAC。记录两组患者开启七氟醚挥发罐(T1)及呼气末七氟醚浓度(C_(ET)Sev)达到0.7 MAC(T2)时的BIS值、体温、平均动脉压(MAP)、心率(HR)、“洗入”时间(T1至T2的时间)以及挥发罐调节次数。结果H组患者“洗入”时间为(102.8±8.6)s,与L组相比显著缩短[(198.0±16.4)s,P=0.010]。两组患者T1、T2时间点的MAP、HR、体温、P_(ET)CO_(2)及BIS值,差异均无统计学意义。L组与H组患者累计调节挥发罐次数[(3.6±0.3)次vs(3.4±0.3)次]和七氟醚平均消耗量(11.95 mL/h vs 12.02 mL/h)差异无统计学意义。结论静吸复合麻醉中,七氟醚Fd设定为3 MAC和2 MAC都可以在静脉麻醉药物作用未消退前,使患者C_(ET)Sev达到0.7 MAC,从而满足手术需要。若要缩短七氟醚的“洗入”时间,挥发罐浓度设定为3 MAC是不错的选择。Objective To explore the effects of different initial concentration of sevoflurane vaporizer(Fd)on the“washing”time and anesthetic depth in combined intravenous-inhalation anesthesia.Methods A total of 80 patients who underwent pelvic or abdominal surgery in Tumor Hospital Affiliated to Nantong University from February 2020 to May 2022 were selected and treated with combined intravenous-inhalation anesthesia.According to the different Fd,the patients were randomly divided into high concentration group(group H,n=40)and low concentration group(group L,n=40).After induction of intravenous anesthesia,the sevoflurane vaporizer was opened and the fresh gas flow(FGF)was adjusted to 2 L/min.According to the patient’s age,Fd was adjusted to 3 minimum alveolar concentration(MAC)and 2 MAC,respectively in group H and group L.The BIS,body temperature,mean arterial pressure(MAP),heart rate(HR),vaporizer opening time(T1),time of end-expiratory sevoflurane concentration(C_(ET)Sev)reaching 0.7 MAC(T2),“washing”time(time from T1 to T2)and regulation times of vaporizer were compared between the two groups.Results The“washing”time in group H was(102.8±8.6)s,which was significantly shorter than that in group L([198.0±16.4]s,P=0.010).There was no significant difference in MAP,HR,body temperature,P_(ET)CO_(2) and BIS between the two groups at T1 and T2 time.There was no significant difference in the regulation times of vaporizer([3.6±0.3]times vs[3.4±0.3]times)and sevoflurane consumption(11.95 mL/h vs 12.02 mL/h)between the two groups.Conclusions In combined intravenous-inhalation anesthesia,sevoflurane Fd setting of 3 MAC and 2 MAC can reach enough anesthetic depth before the effect of intravenous anesthetic wearing away.To shorten the“washing”time of sevoflurane,vaporizer setting at 3 MAC is a good choice.

关 键 词：七氟醚 静吸复合麻醉 最低肺泡有效浓度 “洗入”时间 麻醉深度 

分 类 号：R614[医药卫生—麻醉学]