游离皮瓣乳房重建术中丙泊酚与七氟烷麻醉效果的对比

徐亚军; 杨礼; 黄乃思; 许平波; 朱敏敏; 缪长虹; 楼菲菲; 吴炅

doi:10.12025/j.issn.1008-6358.2017.20170359

摘要: 目的：比较游离皮瓣乳房重建术中丙泊酚与七氟烷麻醉的有效性及安全性。方法：收集采用丙泊酚全凭静脉麻醉维持（P组，n＝16）或七氟烷吸入麻醉维持（S组，n＝19）进行游离皮瓣乳房重建术患者的资料。回顾性分析术后并发症、术后恶心呕吐（postoperative nausea and vomiting, PONV）发生率及术中平均动脉压。结果：两组患者一般资料、手术时间和麻醉时间差异无统计学意义。P组和S组皮瓣危象发生率分别为6.3%和10.5%。两组患者既往PONV史、晕动病史及吸烟史差异无统计学意义。两组患者术中舒芬太尼、瑞芬太尼及术后经静脉患者自控镇痛( patient controlled intravenous analgesia,PCIA)使用情况差异无统计学意义。P组术后0~2 h恶心发生率低于S组（18.8% vs 68.4%，P＝0.003）；P组术后2~6 h和0~24 h呕吐发生率低于S组（18.8% vs 52.6%，P＝0.039；18.8% vs 57.9%，P＝0.019）。两组患者术前平均动脉压差异无统计学意义［(88.06±6.86) mmHg vs (88.10±8.13) mmHg，P＝0.987］；两组患者在术中不同时点平均动脉压均低于术前（P＜0.05）；S组术中不同时点平均动脉压均低于P组（P＜0.05）。S组术中麻黄碱使用量大于P组（P＜0.05）。两组均未发生术中知晓；两组间术后拔管时间、24 h恢复质量评分差异无统计学意义。结论：丙泊酚和七氟烷对游离皮瓣乳房重建术后皮瓣转归的影响无明显差异；与七氟烷相比，丙泊酚可降低术后PONV发生率，提高术中血流动力学稳定性。

Abstract: Objective：To compare the efficacy and safety between propofol and sevoflurane in free flap breast reconstruction. Methods：The data of patients, who underwent free flap breast reconstruction with propofol (P group, n=16) or sevoflurane (S group, n=19), were collected. Postoperative complications of flap, postoperative nausea and vomiting （PONV） and intraoperative mean arterial blood pressure were retrospectively analyzed. Results：No statistical significance of the baseline patient characteristics, duration of surgery and anesthesia was found between the two groups. The incidence of flap compromise was 6.3％in the P group while it was 10.5％ in the S group. No statistical significance of the history of PONV, motion sickness and smoking was found between two groups. Also no statistical significance of intraoperative sufentanil and remifentanil administered, postoperative PCIA consumption was found between the two groups. The incidence of nausea (from 0 to 2 h) was significantly decreased in the P group (18.8% vs 68.4%, P=0.003). The incidences of vomiting (from 2 to 6 h, 0 to 24 h) were significantly reduced in the P group (18.8% vs 52.6%, P=0.039; 18.8% vs 57.9%, P= 0.019). No statistical significance of preoperative mean arterial blood pressures was found between two groups （［88.06±6.86］ mmHg vs ［88.10±8.13］ mmHg，P＝0.987）. Significant decreases in intraoperative mean arterial blood pressures compared with preoperative mean arterial blood pressures were observed in both groups（P＜0.05）. Intraoperative mean arterial blood pressure was lower in the S group compared with the P group(P＜0.05). More ephedrine was used in the S group (P＜0.05). There was no intraoperative awareness in both groups. There were no significant differences in extubation time and 24 h quality of recovery score between the two groups. Conclusions：There was no difference in the outcome of flap between propofol and sevoflurane. Compared with sevoflurane, propofol improves postoperative nausea and vomiting with less intervention in mean arterial blood pressure.