几种静脉全麻药麻醉中知晓及遗忘作用的临床比较

目的　对比观察异丙酚、乙咪酯、硫喷妥钠三种静脉全麻药麻醉中知晓及麻醉遗忘作用 ,以寻求更适合腹腔镜胆囊切除术快速连台要求的速短效麻醉方法。方法　同期腹腔镜胆囊切除术32 5例 ,随机分为三组 ,分别用异丙酚 2mg·kg 1 、乙咪酯 0 4mg·kg 1 、硫喷妥钠 5mg·kg 1 诱导麻醉。其他诱导药物相同 (有东莨菪碱 0 .3mg、芬太尼 5 μg·kg 1 、琥珀胆碱 1 .5mg·kg 1 )。麻醉维持用 1 %普鲁卡因和 0 .0 8%琥珀胆碱复合液。术后 48h内双盲法收集麻醉中知晓资料。结果　三组知晓分别为 1 4%、5 .6%、1 3.5 % (P <0 .0 5 ) ,无痛知晓异丙酚优于其他二种 (P <0 .0 5 ) ,术毕下台知晓、离室知晓、离室清醒例数异丙酚高于另二种 (P <0 .0 5 ) ,术中作梦发生率分别为 7.9%、3.7%、4.8%(P >0 .0 5 ) ,拔管时间及离室时间异丙酚最快 (P <0 .0 5 ) ,硫喷妥钠与乙咪酯差别不大。结论　异丙酚麻醉作用时间最短 ,知晓发生率最高 ;乙咪酯麻醉作用时间长于异丙酚 ,遗忘作用最强 ;硫喷妥钠麻醉苏醒类似于乙咪酯 ,术中知晓与异丙酚相似。应根据手术 ,有针对性的选择用药。

Clinical comparison of three kinds of intravenous anesthetics about perioperative awareness and forgetfulness

Objective We obsrerved the perioperation awareness and the forgetfulness of patients induced by propofol, etomidate and thiopental to explore the fast induction and revivification anesthesia method suited to laparoscopic cholecystectomy. Methods 325 patients underwent LC procedure were randomly in 3 groups:group 1(=114) induced by propofol in of 2?mg ·kg 1 ; group 2 (=107) induced by etomidate in of 0.4?mg·kg 1 ;group 3 (=104) induced by thiopental in dosage of 5 mg·kg 1 . In addition,scopolamine 0.3?mg, fentanly 5?μg·kg 1 and succinylcholine 1.5?mg·kg 1 were used in induction of three groups. The maintaince after induction was performed by infusion of 1% procaine and 0.08% succinylcholine.Information of awareness was biblindly obtained within 24～48 hours after operation.Results The perioperative awareness of 3 groups were 14%,5.6% and 13.5%,respectively ( P <0.05).Moreover the propofols' group had the highest incidence of awareness and revivificatioin from when operation completed to when leaving operation room. The painless awareness of propofol group occurred least in 3 groups. The rate of dream of 3 groups during the operation were 7.9%,3.7% and 4.8%,respectively ( P >0.05).Conclusion Propofol has the shortest course anesthesia in three anesthetics. But it has the highest rate of awareness. Etomidate's anesthetizing time is longer than propofol's and it has the strongest effect of forgetfulness. Thiopental's anesthetizing time is similar to etomidate's, however its'perioperative incidence of awareness is similar to propofol's. So we should depend on requiring of operation and select right anesthetics to meet not only the relaxation of muscle but analgesia and forgetfulness also.