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連續標靶控制輸注propofol與吸入性麻醉藥sevoflurane運用於接受乳房手術之女性病人的成效分析
2012/5/27 連續標靶控制輸注propofol與吸入性麻醉藥sevoflurane運用於接受乳房手術之女性病人的成效分析 主講：許雅惠 林口長庚醫院麻醉科
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研究目的 主要在利用聽覺誘發電位偵測儀(auditory evoked potential, AEP)來監測麻醉深度以探討術中連續標靶輸注(TCI)-propofol與使用吸入性麻醉藥Sevoflurane等兩種全身麻醉方法的成效比較以提供乳房手術病人及麻醉執行者在選擇麻醉方式時的參考。
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研究方法 研究期間為100年3月至100年12月31日止(CGMHIRB no: 99-3537A3)
收錄84位接受插管全身麻醉的女性乳房手術病人資料 ASA:I~II 年齡:20~70歲 手術時間:1~4小時 無懷孕、無聽力障礙、無精神疾病、對propofol無過敏、無腸胃疾病且於手術前24小時內無使用止吐藥、類固醇及止痛藥
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研究方法 A組：術中麻醉維持使用TCI輸注propofol B組：術中麻醉維持以吸入性麻醉藥Sevoflurane為主
個案麻醉誘導用藥:fentanyl (2mcg/kg) 2% lidocaine (0.5 mg/kg), cisatracurium (0.2 mg/kg) 及propofol(2 mg/kg)
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統計分析 SPSS version 19.0 for windows (SPSS Inc., Chicago, IL)
卡方檢定(Chi-square test) 獨立t檢定 (independent-t)
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結果與探討 Table 1 Patient Characteristics Propofol (n=42) Sevo P value
Female gender 42 (100) Age(yr) 51.17±9.09 48.67±10.10 0.24 Height(cm) 157.52±4.91 156.86±5.84 0.56 Weight(kg) 60.52±10.45 57.64±8.51 0.17 BMI(kg/m2) 24.43±4.24 23.54±4.08 0.34 Surgical Duration(min) 122.02±45.86 142.57±46.23 0.06
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結果與探討 Table 2 Intraoperative and postoperative data Propofol (n=42)
Sevo P value Intubation time(min) 3.95±1.09 3.79±1.29 0.51 Extubation time(min) 13.38±6.78 13.02±5.26 0.81 PAR time(min) 83.02±10.55 88.52±15.21 0.07 Length of hospital stay (day) 3.36±1.19 4.60±1.20 <0.001
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結果與探討 Table 3 Basic Cost Assumptions for the Economic Analyses
Drug acquisition costs NTD Propofol 1% (20ml) 57 Sevoflurane (250ml) 4350 Fentanyl (10ml) 98 Cisatracurium (5ml) 92
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結果與探討 Table 4 Amount of intraoperative anesthetic drugs used in the two groups Propofol (n=42) Sevo P value Fentanyl (ml) 3.40 ± 0.80 3.36 ± 0.66 0.77 Fentanyl(mcg) ± 39.91 ± 32.80 Cisatracurium (PC) 2.12 ± 0.50 2.02 ±0.35 0.31 Cisatracurium (mg) 17.43 ± 5.30 15.64 ± 3.38 0.07 Propofol (PC) Including wastage 7.71 ± 3.24 1 ± 0.00 - Sevoflurane (ml) 32.9 ± 11.46
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結果與探討 Table 5 Cost analysis Cost (NTD) Propofol (n=42) Sevo Fentanyl
Cisatracurium Sevoflurane 33.37 ±7.64 194.95±45.26 ± - 32.93 ±6.47 185.84±32.20 57 ± Total cost ± 222 ±
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結果與探討 Table 6 Quality of Postoperative complications in the two anesthetic groups Propofol (n=42) Sevo P value PONV 6 (14.3) 21 (50.0) <0.001 Nausea 3 (7.1) 15 (35.7) 0.001 Vomiting 5 (11.9) 14 (33.3) 0.019 Dizziness 7 (16.7) 0.048 Required NSAID analgesic at PACU 4 (9.5) 0.697
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結論 A組 B組 Propofol Sevoflurane 麻醉藥物費用(NTD) 668±222 848±209.38
PONV發生率人次(%) 6 (14.3) 21 (50.0) 住院天數(天) 3.36±1.19 4.60±1.20
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結論 TCI-propofol 結果顯示連續標靶輸注(TCI)-propofol在麻醉藥物費用較低、PONV的發生率較低、住院天數亦較短。
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研 究 貢 獻 提供醫療團隊人員，對於兩種麻醉方式的成本差異及麻醉品質的瞭解，並可作為選擇麻醉方式之參考。
作為醫護人員在研發或驗證新技術時之參考範本，在同時考量照護成本及麻醉品質的條件下，使病患得到最好的麻醉照護。
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參 考 文 獻 William E., Hurford, Michael T., Bailin J., Kenneth Davison,Kenneth L., Haspel Carl ROSOW.(2001) ．MGH臨床麻醉手冊（蔡蓮貴譯）．台北：九州（2000） Gilles Godet, Christine Watremez, Chaffik El Kettani, Christina Soriano, and Pierre Coriat. A Comparison of Sevoflurane, Target-Controlled Infusion Propofol, and Propofol/Isoflurane Anesthesia in Patients Undergoing Carotid Surgery: A Quality of Anesthesia and Recovery Profile, Anesth Analg 2001;93:560–5. I. Smith, P. A. Terhoeve, D. Hennart, P. Feiss, M. Harmer, J.L. Pourriat and I. A. T. Johnson. A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol, British Journal of Anaesthesia 1999;83(4): K. R. Watson and M. V. Shah. Clinical comparison of ‘ single agent‘ anaesthesia with sevoflurane versus target controlled infusion of propofol, British Journal of Anaesthesia 2000;85(4):541-6. Patricia O. Fombeur, Patrick R. Tilleul, Marc J. Beaussier, Christine Lorente, Lassaad Yazid, and Andre H. Lienhart. Cost-effectiveness of propofol anesthesia using target-controlled infusion compared with a standard regimen using desflurane, Am J Health-Syst Pharm 2002;59: Ritva M. Jokela, Tuula A. Kangas-Saarela, Jukka V. I. Valanne, Merja K. Koivuranta, Pirjo O. Ranta, and Seppo M. Alahuhta. Postoperative Nausea and Vomiting After Sevoflurane With or Without Ondansetron Compared with Propofol in Female Patients Undergoing Breast Surgery, Anesth Analg 2000; 91:1062–5. Shun-Ming Chan, Huei-Chi Horng, Shun-Tsung Huang, Hsin-I Ma, Chih-Shung Wong, Chen-Hwan Cherng, and Ching-Tang Wu. Drug Cost Analysis of Three Anesthetic Regimens in Prolonged Lumbar Spinal Surgery, J Med Sci 2009;29(2):75-80 Smith and A. J. Thwaites. Target-controlled propofol vs. sevoflurane: a double-blind, randomised comparison in day-case anaesthesia, Anaesthesia 1999;54:745–52. Stefan Suttner, Joachim Boldt, Christian Schmidt, Swen Piper, and Bernhard Kumle. Cost Analysis of Target-Controlled Infusion-Based Anesthesia Compared with Standard Anesthesia Regimens, Anesth Analg 1999;88:77–82..
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