目的：比较七氟烷和瑞芬太尼在老年手术麻醉中维库溴铵的协同作用及术后苏醒等方面的差异。方法选择择期行腹腔镜胆囊切除术的气管内插管全身麻醉的患者30例,随机分成两组,每组15例。麻醉诱导均采用咪达唑仑(0.05 mg/kg)、维库溴铵(0.1 mg/kg)、丙泊酚3.5μg/ml联合诱导插管, S组病例吸入七氟烷维持呼气末浓度为1.0MAC, R组病例静脉靶控瑞芬太尼(5 ng/ml)。观察两组患者维库溴铵起效时间(onset time)、临床持续时间(DUR25)、T1/T0(%)恢复到50%的时间(DUR50)、恢复指数(RI)、TOF(T4/T1)=0.7的时间以及停药到睁眼的时间。结果 S组的起效时间、DUR25、DUR50均明显短于R组,而RI、TOF(T4/T1)=0.7的时间及睁眼时间均明显长于R组,差异有统计学意义(P<0.05)。结论在老年患者全身麻醉中,与复合瑞芬太尼相比,复合七氟烷麻醉能使维库溴铵肌松作用增强,消退时间延长。%Objective To compare the effects of sevoflurane and remifentanil on vecuronium-induced neuromuscular block and awakening in the eldly. Methods Thirty patients (ASA II-III) aged 65-80 undergoing laparoscopic cholecystectomy were randomly allocated into two groups, sevoflurane group (group S, n=15) and remifentanil group (group R, n=15). Both groups were induced with midazolam(0.05 mg/kg), vecuronium (0.1 mg/kg) and propofol (3.5μg/ml), maintained with inhalation of 1.0MAC end-tidal concentration of sevoflurane (Group S) or TCI remifentanil 5 ng/ml(group R). The onset time, DUR25,DUR50, recovery index(RI), the time of TOF (T4/T1)=0.7 and eye-opening time were observed. Results The onset time, DUR25, DUR50 of group S were shorter than group R, while RI, the time of TOF(T4/T1)=0.7 and eye-opening time were longer(P<0.05). Conclusion Compared to combined remifentanil, combined sevoflurane would enhance the effect of vecuronium , and prolong the neuromuscular blocking effect.
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