关键词: 丙泊酚； 七氟醚； 交替维持； 苏醒质量； 全身麻醉

Abstract: Objective To study the effect of intermittent alternating maintenance of propofol and sevoflurane on the clinical effect of patients with long-time general anesthesia.Methods A total of 90 patients with elective abdominal surgery from June 2023 to June 2024 were selected and divided into three groups (n=30) by computer random number table method,propofol intravenous maintenance group (group A),propofol combined with sevoflurane maintenance group ( group B) and intermittently maintenance of propofol and sevoflurane group (group C).All patients underwent tracheal intubation after routine intravenous induction, with 30 cases in each group.Group A was maintained by propofol and remifentanil,group B was maintained by propofol combined with sevoflurane and remifentanil,and group C was maintained by propofol alternate with sevoflurane and remifentanil.The dosage of each anesthesia drug,the recovery time of breathing,awareness time,extubation time and the total recovery time after the operation were recorded,and the restlessness at recovery (RS) score and Ramsay sedation score were evaluated.Adverse events and complications were recorded.Postoperative ICU stay,total hospital stay,and hospitalization expenses were also counted.Results The doses of propofol in groups A,B,and C were (1 740.3±385.6) mg,(1 243.2±278.5) mg and (1 055.1±245.8) mg,respectively,and the doses of sevoflurane in groups B and C were (39.83±9.20) mg and (28.33±4.25) mg,respectively.Compared with group A and B,group C used less propofol and sevoflurane (P<0.05).Postoperatively,patients in group C had shorter recovery times for spontaneous breathing [(15.43±14.90)min],consciousness awakening [(15.90±14.59)min],extubation [(42.82±37.23)min],and total recovery time [(44.03±12.68)min] than those in group A[（56.73±47.23）min,（57.03±47.83）min,（66.43±47.94）min and（93.80±48.68）min] and group B[（31.57±26.04）min,（31.17±26.06）min,（39.60±26.30）min and（65.43±34.18）min] (P<0.05).The RS scores for groups A,B,and C were (1.33±0.92),(0.83±0.70),and (0.33±0.55),respectively,and the Ramsay sedation scores were (2.87±0.94),(2.43±0.73),and (1.90±0.40),respectively,showing a gradual decrease (P<0.05).The incidences of postoperative choking cough, restlessness, nausea and vomiting, and hypotension in group A were 26.7%, 36.7%, 23.3%, and 30% respectively, and those in group C were 6.7%, 6.7%,3.3%,and 10% respectively. The incidences in group C were all lower than those in group A, and the differences were statistically significant (P < 0.05).Furthermore,compared with group A[（2.53±1.14）d,（25.53±13.17）d and（93 200±19 800）CNY],group C had shorter ICU stays [(1.50±0.68)d] and hospitalization durations [(20.37±6.67)d],and lower hospitalization costs [(84800±10700）CNY] (P<0.05).Conclusion Propofol and sevoflurane intermittently maintenance can be safely and effectively used for long-time anesthesia maintenance.Compared with traditional total intravenous and intravenous combined with inhalation anesthesia,the recovery is faster,the recovery quality is better,and the hospitalization time and cost can be optimized.

Key words: propofol; sevoflurane; intermittent alternation; quality of recovery; general anesthesia