CAJ | 학술논문

目的：比较异丙酚/瑞芬太尼静脉麻醉与七氟烷吸入全身麻醉在鼻内镜手术患者中的应用效果。方法：随机选择ASA I-II级的鼻内镜手术患者40例，分成2组，即异丙酚/瑞芬太尼静脉维持麻醉组（T组）和七氟烷吸入维持麻醉组（S组），2组均采用静脉诱导。T组气管插管后微量注射泵静脉输注异丙酚、瑞芬太尼维持麻醉，S组气管插管后吸入七氟烷维持麻醉，使脑电双频指数（BIS）在45～60之间。记录入室后（T0）、诱导后（T1）、插管后1 min（T2）、插管后3 min（T3）、拔管后1 min（T4）、拔管后3 min（T5）的平均动脉压（MAP）、心率（HR）、氧饱和度（SpO2）和BIS值，记录苏醒时间、拔管时间、术中降压药使用频率以及术后躁动、恶心呕吐、过度镇静等不良反应发生例数。结果：与S组比较，T组MAP在T3时较低（P＜0.05），SpO2在T5时较低（P＜0.05）。与T0时比较，S组MAP在T1～T3时降低，T4时升高（P＜0.05），HR在T4时加快（P＜0.05），SpO2在T1～T3时增加（P＜0.05）；T组MAP在T1～T3时降低（P＜0.05），HR在T3时减慢（P＜0.05），SpO2在T1～T3时增加，在T5降低（P＜0.05）。与S组比较，T组苏醒时间短（P＜0.05），Ramsay镇静评分高（P＜0.05），苏醒期躁动发生率低（P＜0.05），术中需额外降压药行控制性降压例数较少（P＜0.05）。结论：鼻内镜手术采用异丙酚/瑞芬太尼静脉麻醉与采用七氟烷吸入麻醉比较，围术期血压控制稳定，苏醒快，躁动发生率低。
목적：비교이병분/서분태니정맥마취여칠불완흡입전신마취재비내경수술환자중적응용효과。방법：수궤선택ASA I-II급적비내경수술환자40례，분성2조，즉이병분/서분태니정맥유지마취조（T조）화칠불완흡입유지마취조（S조），2조균채용정맥유도。T조기관삽관후미량주사빙정맥수주이병분、서분태니유지마취，S조기관삽관후흡입칠불완유지마취，사뇌전쌍빈지수（BIS）재45～60지간。기록입실후（T0）、유도후（T1）、삽관후1 min（T2）、삽관후3 min（T3）、발관후1 min（T4）、발관후3 min（T5）적평균동맥압（MAP）、심솔（HR）、양포화도（SpO2）화BIS치，기록소성시간、발관시간、술중강압약사용빈솔이급술후조동、악심구토、과도진정등불량반응발생례수。결과：여S조비교，T조MAP재T3시교저（P＜0.05），SpO2재T5시교저（P＜0.05）。여T0시비교，S조MAP재T1～T3시강저，T4시승고（P＜0.05），HR재T4시가쾌（P＜0.05），SpO2재T1～T3시증가（P＜0.05）；T조MAP재T1～T3시강저（P＜0.05），HR재T3시감만（P＜0.05），SpO2재T1～T3시증가，재T5강저（P＜0.05）。여S조비교，T조소성시간단（P＜0.05），Ramsay진정평분고（P＜0.05），소성기조동발생솔저（P＜0.05），술중수액외강압약행공제성강압례수교소（P＜0.05）。결론：비내경수술채용이병분/서분태니정맥마취여채용칠불완흡입마취비교，위술기혈압공제은정，소성쾌，조동발생솔저。
Objective:To compare the effect of total intravenous anesthesia with sevoflurane inhalation anesthesia in endoscopic sinus surgery. Methods:Forty patients of ASA I and II undergone selective endoscopic sinus surgery were randomly divided into two groups:group T (remifentanyl 5~10μg/kg/h and propofol 4~8 mg/kg/h maintenance anesthesia), group S (sevolfurane 0.8~1.0 MAC maintenance anesthesia), and induced by intravenous in both groups. The lfuctuation of the BIS values should be controlled between 45 and 60 during the surgery. Hemodynanmic parameters including MAP, HR, and SpO2 were recorded continuously, especially before induction (T0), after induction before intubation (T1), 1 minute after intubation (T2), 3 minutes after intu-bation (T3), 1 minute after extubation (T4), and 3 minutes after extubation (T5). Operation time, recovery time, extubation time, the case of using hypotensive drugs during perioperation and the incidence of side effects after postoperation such as dysphoria, PONV, severe sedation were also recorded. Results:Compared with group S, the MAP at T3 and the SpO2 at T5 were declined in group T (P<0.05). Compared with T0, the MAP at T1~T3 were lower and at T4 was risen in group S (P<0.05), the HR at T4 was accelerated in group S (P<0.05). The MAP at T1~T3 was lower in group T (P<0.05), and the HR at T3 was slower in group T (P<0.05), the SpO2 at T1~T3 was risen and T5 was lower in group T (P<0.05). Compared with S group, the recovery time in group T was shorter (P<0.05), the incidence of emergence agitation in group T was lower (P<0.05), and the Ramsay sedation score in group T was higher (P<0.05), the cases of patients need controlled hypotension were less (P<0.05). Conclusion:The anesthesia effectiveness of propofol/remifentanyl intravenous anesthesia is more suitable and safer for endo-scopic sinus surgery than sevolfurane inhaled maintenance anesthesia, the MAP is easier to adjust for the satisfac-tion of requirement of operation, revival time is faster, but incidence of agitation is loss.