Ihn C H, Joo J D, Choi J W, Kim D W, Jeon Y S, Kim Y S, Jung H S, Kwon S Y
Department of Anaesthesiology and Pain Medicine, St Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Int Med Res. 2009 Nov-Dec;37(6):1760-71. doi: 10.1177/147323000903700612.
This prospective randomized study compared the effects of two types of anaesthesia on peri-operative anaesthetic profiles from induction to recovery and on immunological and neurohormonal responses to anaesthesia and surgical stress. Forty patients were assigned to undergo either volatile induction and maintenance of anaesthesia (VIMA) with sevoflurane or total intravenous anaesthesia (TIVA) with propofol and remifentanil. Plasma adrenaline, noradrenaline, cortisol, glucose and interleukin-6 (IL-6) levels were measured at baseline, induction, incision and extubation. TIVA produced a significantly lower intubation score, shorter time to intubation and faster waking time than VIMA, but recovery profiles did not differ. Adrenaline, noradrenaline, cortisol and glucose levels were significantly lower with TIVA than VIMA, but there was no difference in IL-6 levels between the two groups. TIVA with propofol and remifentanil may be preferable to VIMA with sevoflurane alone because it leads to smoother, more rapid induction, more rapid awakening and lower stress responses to surgical stimuli.
这项前瞻性随机研究比较了两种麻醉方式对围手术期麻醉情况（从诱导到苏醒）以及对麻醉和手术应激的免疫和神经激素反应的影响。40名患者被分配接受七氟醚挥发性诱导和维持麻醉（VIMA）或丙泊酚与瑞芬太尼全静脉麻醉（TIVA）。在基线、诱导、切口和拔管时测量血浆肾上腺素、去甲肾上腺素、皮质醇、葡萄糖和白细胞介素-6（IL-6）水平。与VIMA相比，TIVA产生的插管评分显著更低、插管时间更短且苏醒时间更快，但恢复情况没有差异。TIVA组的肾上腺素、去甲肾上腺素、皮质醇和葡萄糖水平显著低于VIMA组，但两组间IL-6水平没有差异。丙泊酚与瑞芬太尼的TIVA可能比单独使用七氟醚的VIMA更可取，因为它能带来更平稳、更快速的诱导、更快的苏醒以及对手术刺激更低的应激反应。
