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| 丙泊酚和七氟醚麻醉维持应用于喉返神经监测下甲状腺手术效果的比较 |
| Comparison of propofol and sevoflurane anesthesia maintenance in thyroid operation with intra-operative neuromonitoring |
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| DOI：10.12089/jca.2021.09.010 |
| 中文关键词: 甲状腺手术 丙泊酚 七氟醚 喉返神经监测 罗库溴铵 |
| 英文关键词: Thyroid surgery Propofol Sevoflurane Intra-operative neuromonitoring Rocuronium |
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| 中文摘要: |
目的 比较丙泊酚和七氟醚麻醉维持在喉返神经监测下甲状腺手术的麻醉效果。
方法 选择2018年9—12月需行喉返神经监测下甲状腺手术的患者80例,男40例,女40例,年龄22~45岁,BMI 19~27 kg/m2,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组：丙泊酚麻醉维持组(P组)和七氟醚麻醉维持组(S组),每组40例。P组采用静脉泵注丙泊酚4~6 mg·kg-1·h-1麻醉维持,S组吸入1.5%~2.5%七氟醚麻醉维持。监测左手拇内收肌肌肉松弛程度,分别记录给予罗库溴铵后TOF值下降达75%、50%、0、恢复4个成串刺激、TOF值恢复至50%和恢复至75%的时间。记录术中高血压、低血压、窦性心动过速、窦性心动过缓、阿托品使用、体动发生情况。记录停麻醉药到清醒拔管时间、术后躁动、嗜睡、咽痛、恶心呕吐发生情况。记录喉返神经首次监测时间和首次监测成功例数。
结果 与P组比较,S组达到恢复4个成串刺激、TOF值恢复至50%和恢复至75%的时间明显延长(P<0.05),术中低血压发生率明显升高(P<0.05),体动发生率明显降低(P<0.05),停麻醉药到清醒拔管时间明显缩短(P<0.05)。两组术后躁动、咽痛、恶心呕吐发生率及术中神经监测情况比较差异均无统计学意义。
结论 应用丙泊酚和七氟醚均可满足行喉返神经监测下甲状腺手术患者的麻醉维持需求,与丙泊酚4~6 mg·kg-1·h-1麻醉维持比较,吸入1.5%~2.5%七氟醚麻醉维持时肌松恢复时间长,术中体动少且不影响神经监测,因此更有优势。 |
| 英文摘要: |
Objective To compare propofol and sevoflurane with remifentanil in thyroid operation with intra-operative neuromonitoring.
Methods Eighty patients scheduled to receive a thyroid operation under general anesthesia from September 2018 to December 2018 were enrolled,40 males and 40 females, aged 22-45 years, BMI 19-27 kg/m2, ASA physical status Ⅰor Ⅱ, were randomly assigned to two groups: propofol group (group P) and sevoflurane group (group S), 40 patients in each group. Group P treated with propofol 4-6 mg·kg-1·h-1 anesthesia maintenance, and group S treated with 1.5% to 2.5% sevoflurane anesthesia maintenance, respectively. Record gender, age, BMI and operation data. The time of TOF decreased by 75%, 50%, 0, recovered four series of stimuli, recovered to 50%, and recovered to 75% after rocuronium administration. Adverse events such as hypertension, hypotension, sinus bradycardia, tachycardia, usage of atropine and movement were recorded. Analyze the time from anesthetic stop to the extubation time and operation time. Record the incidence rate of agitation, drowsiness, sore throat, nausea and vomiting after extubation. Record the first neuromonitoring time and the case of successful neuromonitoring.
Results Group S had longer time in the recovery profile of rocuronium than group P (P < 0.05). Group S had more hypotension and less movement than group P (P < 0.05). There was no significance difference of sinus braducardia event between the two groups. Group S had shorter extubation time than group P (P < 0.05). The incidence of agitation, nausea and vomiting in the two groups was similar during the recovery period, and the difference was not statistically significant. There was no significant difference of neuromonitoring between the two groups.
Conclusion Propofol and sevoflurane are effective in the thyroid operation with intra-operative neuromonitoring in anesthesia maintenance, 1.5% to 2.5% sevoflurane inhaled has advantage than propofol 4-6 mg·kg-1·h-1 intravenous when associated remifentanil with less movement during operation． |
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