目的 比較七氟醚和丙泊酚不同麻醉方案用于腹腔鏡手術(shù)的臨床研究和經(jīng)濟(jì)效益。方法 2011年1月—2013年12月陽谷縣中醫(yī)院收治的行腹腔鏡手術(shù)治療的患者200例，隨機(jī)分為七氟醚組（66例）、丙泊酚組（67例）和聯(lián)合組（67例）。分別給予七氟醚全程吸入麻醉、丙泊酚靶控輸注麻醉和靜脈注射丙泊酚誘導(dǎo)-吸入七氟醚維持麻醉3種不同麻醉方案。比較3組患者麻醉和蘇醒質(zhì)量、麻醉費(fèi)用、不良反應(yīng)發(fā)生率，同時(shí)于術(shù)前、術(shù)后3 d檢測免疫反應(yīng)指標(biāo)。結(jié)果 七氟醚組意識(shí)消失時(shí)間顯著短于聯(lián)合組，丙泊酚組高于聯(lián)合組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；丙泊酚組意識(shí)消失時(shí)間、氣管插管時(shí)間、定向力恢復(fù)時(shí)間均顯著長于七氟醚組、聯(lián)合組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。七氟醚組、丙泊酚組麻醉誘導(dǎo)費(fèi)用、麻醉維持費(fèi)用、總費(fèi)用及每分鐘費(fèi)用均顯著高于聯(lián)合組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；丙泊酚組麻醉誘導(dǎo)費(fèi)用、麻醉維持費(fèi)用、總費(fèi)用及每分鐘費(fèi)用均顯著高于七氟醚組，但追加麻醉費(fèi)用低于七氟醚組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。3組患者術(shù)后3 d CD4、CD8、CD4/CD8與同組術(shù)前比較差異無統(tǒng)計(jì)學(xué)意義，且3組患者CD4、CD8、CD4/CD8水平差異亦無統(tǒng)計(jì)學(xué)意義。結(jié)論 在麻醉及麻醉恢復(fù)質(zhì)量相近的情況下，腹腔鏡手術(shù)麻醉方案中，靜脈注射丙泊酚誘導(dǎo)-吸入七氟醚維持麻醉是最為經(jīng)濟(jì)的方案，值得臨床推廣應(yīng)用。

Objective To compare the clinical efficacy and pharmacoeconomic analysis of different anesthetic solution of sevoflurane and propofol for laparoscopic surgery. Methods The patients (200 cases) accepted laparoscopic surgery in the Traditional Chinese Medicine Hospital of Yanggu County from January 2011 to December 2013 were randomly divided into sevoflurane (66 cases), propofol (67 cases), and combined (67 cases) groups. The patients in the three groups were given the inhalation of sevoflurane anesthesia, target-controlled infusion of propofol anesthesia, and iv propofol for induction of anesthesia-inhalation of sevoflurane for maintenance of anesthesia. The quality of anesthesia and awakening, cost of anesthesia, incidence of adverse drug reactions were compared in the three groups. At the same time, the indexes of immune response in preoperative and postoperative 3 d were detected. Results Consciousness disappearing time in sevoflurane group was significantly shorter than that in the combined group, while the time in the propofol group was longer than that in the combined group, and there were differences between the two groups (P < 0.05).Consciousness disappearing time, endotracheal intubation time, directional force recovery time in the propofol group were significantly longer than those in the sevoflurane and combined groups, and there were differences between the two groups (P < 0.05). Anesthesia induction costs, anesthesia maintenance costs, total cost, and per minute cost in the sevoflurane and propofol groups were significantly higher than those in the combined group, and the difference was statistically significant (P < 0.05). Anesthesia induction costs, anesthesia maintenance costs, total cost, and per minute cost the in propofol group were significantly higher than those in the sevoflurane group, but additional anesthesia cost was lower than that in the sevoflurane group, and there were differences between the two groups (P < 0.05). CD4, CD8, and CD4/CD8 in the three groups were no statistically significant difference in 3 d before and after surgery. The difference of CD4, CD8, and CD4/CD8 in the three groups also had no statistical significance. Conclusion In the case of similar quality of anesthesia and anesthesia recovery, iv propofol for the induction of anesthesia-inhalation of sevoflurane for maintenance of anesthesia is the most economical solution, which is worthy of clinical popularization and application.

國家自然科學(xué)基金資助項(xiàng)目（81171020）