CAJ | 학술논문

目的：比较肺活量法高浓度七氟烷吸入诱导与丙泊酚静脉注射诱导在成人腹腔镜手术的麻醉效果。方法选择腹腔镜手术患者44例,ASA分级I~Ⅱ级,年龄22~65岁,性别不限。采用随机数字表法,将患者分成两组(n=22)：七氟烷吸入诱导组(S组)和丙泊酚静脉诱导组(P组)。 S组诱导采用肺活量法吸入8%七氟烷结合3L/min氧流量诱导至患者意识消失；P组采用丙泊酚、舒芬太尼和顺苯磺酸阿曲库铵依次诱导至患者意识消失。两组麻醉诱导后均插入喉罩,连接呼吸回路行机械通气；两组术中均采用七氟烷吸入结合静脉靶控输注丙泊酚(靶控血浆浓度3~5μg/ml)维持麻醉。观察指标：麻醉诱导前后即刻、置入喉罩前后即刻、手术开始后(5min、15min、30min)和拔除喉罩时患者的HR、MAP、SpO2和PETCO2变化；观察诱导过程中患者意识消失时间、置入喉罩前后即刻的不良反应、一次置入喉罩成功率和气道压；观察患者术后苏醒时间。结果与P组比较,S组诱导时意识消失时间缩短(<0.05)；置入喉罩前后,两组不良反应发生率S组较P组明显减少,且两组不同不良反应发生差异有统计学意义(<0.05)；术后苏醒时间比较,S组的自主呼吸和意识恢复较P组缩短(<0.05)；两组手术开始后15min、30min时和拔出喉罩即刻的HR比较S组快于P组(<0.05)；两组麻醉诱导后、置入喉罩前后即刻以及手术开始5min、15min后即刻患者的MAP比较,P组显著低于S组(<0.05)。结论与丙泊酚静脉麻醉诱导相比,肺活量法七氟烷吸入具有更好的快速麻醉诱导和快速麻醉恢复效果,是腹腔镜手术较理想的麻醉方法之一。
목적：비교폐활량법고농도칠불완흡입유도여병박분정맥주사유도재성인복강경수술적마취효과。방법선택복강경수술환자44례,ASA분급I~Ⅱ급,년령22~65세,성별불한。채용수궤수자표법,장환자분성량조(n=22)：칠불완흡입유도조(S조)화병박분정맥유도조(P조)。 S조유도채용폐활량법흡입8%칠불완결합3L/min양류량유도지환자의식소실；P조채용병박분、서분태니화순분광산아곡고안의차유도지환자의식소실。량조마취유도후균삽입후조,련접호흡회로행궤계통기；량조술중균채용칠불완흡입결합정맥파공수주병박분(파공혈장농도3~5μg/ml)유지마취。관찰지표：마취유도전후즉각、치입후조전후즉각、수술개시후(5min、15min、30min)화발제후조시환자적HR、MAP、SpO2화PETCO2변화；관찰유도과정중환자의식소실시간、치입후조전후즉각적불량반응、일차치입후조성공솔화기도압；관찰환자술후소성시간。결과여P조비교,S조유도시의식소실시간축단(<0.05)；치입후조전후,량조불량반응발생솔S조교P조명현감소,차량조불동불량반응발생차이유통계학의의(<0.05)；술후소성시간비교,S조적자주호흡화의식회복교P조축단(<0.05)；량조수술개시후15min、30min시화발출후조즉각적HR비교S조쾌우P조(<0.05)；량조마취유도후、치입후조전후즉각이급수술개시5min、15min후즉각환자적MAP비교,P조현저저우S조(<0.05)。결론여병박분정맥마취유도상비,폐활량법칠불완흡입구유경호적쾌속마취유도화쾌속마취회복효과,시복강경수술교이상적마취방법지일。
Objective Comparison of vital capacity induction with sevoflurane to intravenous induction with propofol in adult laparoscopic operation. Methods Involved in this study were forty-four adult patients, ASA Ⅰand II, aged 22-65 yr having elective laparoscopic procedure under general anesthesia. According to a randomization based on computer generated codes the patients were randomized into 2 groups (n=22):group S:8%sevoflurane in O2 3L/min was inhalation via a mask over the patient face whom were encouraged to take addition deep breaths until less of consciousness; and group P: Patient were inducted with 2mg/kg propofol, 0.3μg/kg sufentanil and 0.2mg/kg cisatracurium via the peripheral intravenous injuction. The primary outcome was the time to loss of command response, eyelash reflex and muscle tension as wel as inserted successful y. The change of monitoring index including non-invasive blood pressure, heart rate, saturation of pulse oximetry and partial pressure of carbon dioxide in endexpiratory during anesthesia induction as well as time of operative and postoperative anesthetic revival in every patient was also noted. Results Group S had a faster time to achieve loss of command response and muscle tension and inserted successful y as wel as time of postoperative revival ( <0.05); the adverse events occurring during the induction and during the at empted insertion of laryngeal mask, cough, hold breath, movement and laryngospasm was more frequent in the group S;and cough, movement, laryngospasm and fluctuation of blood pressure was more frequent in the group P;heart rate increases after anesthesia induction were least in Group P, and greatest in Group S ( <0.05); group P developed the blood pressure change occurring immediately after induction, immediately before and after the insertion of laryngeal mask as wel as 5min, 15min after operative( <0.05). Conclusion We conclude that a vital capacity induction with high concentration sevoflurane produced a faster loss of consciousness and reduced the incidence of adverse events;and shorten recovery times in adults undergoing laparoscopic operation.