全凭静脉麻醉在腹腔镜胆囊切除术中的应用价值  

Value of Total Intravenous Anesthesia with Propofol and Fentanyl in Larparoscopic Cholecystectomy

作　　者：闫相华[1] 张甲平[1] 陈丽[1] 

机构地区：[1]解放军第18医院麻醉科,新疆叶城844900

出　　处：《临床军医杂志》2004年第5期40-42,共3页Clinical Journal of Medical Officers

摘　　要：目的　探讨普鲁泊福和芬太尼全凭静脉麻醉在腹腔镜胆囊切除术 (LC)的应用及价值。方法　择期LC手术的患者 80例 ,随机等分成静吸复合麻醉组 (静吸组 ) 40例和全凭静脉麻醉组 (静脉组 ) 40例。两组均以咪达唑仑 0 .2 5mg/kg ,芬太尼 2 μg/kg和维库溴铵 0 .1mg/kg诱导后作气管插管。麻醉维持 :静吸组用异氟烷吸入 ,全凭静脉组将普鲁泊福 8mg/(kg·h)和芬太尼 4μg/(kg·h)混合液恒速输入。记录麻醉诱导前、气腹前、气腹后 10min、气腹毕和术毕的SBP ,DBP ,SpO2 ,停止麻醉至拔管的时间 ,拔管时的清醒程度和随访结果。结果　两组间的拔管时间、清醒程度无显著性差异。静吸组在气腹后 10min的HR ,SBP ,DBP及术毕HR明显高于术前基础值 (P <0 .0 5或P <0 .0 1) ,而全凭静脉组术中无明显变化 ,术后恶心呕吐发生率也明显低于静吸组。结论　普鲁泊福和芬太尼全凭静脉麻醉用于LC手术 ,具有麻醉效果满意、血液动力学稳定、苏醒快速、术后恶心呕吐率低等优点 。Objective To study the application of total intravenous anesthesia (TIVA) with propofol and fentanyl to larparoscopic cholecystectomy (LC).Methods Eighty cases of LC were at random allocated into two groups: the combined intravenous and inhalation anesthesia(CIIA)group and the TIVA group. Midazolam (0.25mg/kg), fentanyl (2μg/kg) and vecuronium (0.1 mg/kg) were injected intravenously for induction in both groups. Isofluothane was inhaled in CIIA group, and the mixture of fentanyl \[4μg/(kg·h)\] and propofol \[8 mg/(kg·h)\] was infused in TIVA group to maintain anesthesia. Blood pressure (BP), heart rate (HR) and SpO 2 were monitored. The extubation time and the recovery profiles were recorded. Results There were no significant differences in extubation and operation times between two groups, as well as conscious recovery (P<0.05). HR, systolic and diastolic BP at 10min following the pneumoperitoneum and the HR at the end of the operations in CIIA group were significantly higher than the baselines (P<0.05 or P<0.01) whereas no significant changes occurred in TIVA group. The occurrence rates of nausea and vomiting were significantly lower in TIVA group.Conclusion TIVA with propofol and fentanyl is a better technique to LC with stable hemodynamics.

关 键 词：全凭静脉麻醉 二异丙酚 芬太尼 腹腔镜胆囊切除术 

分 类 号：R614.24[医药卫生—麻醉学] R657.41[医药卫生—外科学]