瑞芬太尼丙泊酚全凭静脉麻醉与静吸复合麻醉用于腹腔镜胆囊切除术的比较  

Comparision of anesthesia with intravenous infusion of remifentanil-propofol versus isoflurane inhalation in patients undergoing laparoscopic cholecystectomy

作　　者：刘建华[1] 沈金美[1] 李李[1] 常业恬[1] 

机构地区：[1]中南大学湘雅二医院麻醉科,长沙410011

出　　处：《中国新药杂志》2006年第3期222-224,共3页Chinese Journal of New Drugs

摘　　要：目的:评价瑞芬太尼-丙泊酚全凭静脉麻醉与静吸复合麻醉应用于腹腔镜胆囊切除术(LC)的临床疗效及不良反应。方法:择期LC手术40例,随机分为静吸复合麻醉组(对照组)和全凭静脉麻醉组(试验组),每组20例。2组均以咪达唑仑0．1 mg·kg～(-1),丙泊酚2 mg·kg～(-1),瑞芬太尼2μg·kg^(-1)和维库溴铵0．1 mg·kg^(-1)诱导后气管插管。麻醉维持,对照组用2%异氟醚吸入,试验组按丙泊酚6 mg·kg～(-1)·h^(-1)和瑞芬太尼0．5μg·kg～(-1)·min^(-1)的速度用微量泵输入。记录麻醉诱导前、气腹前和气腹后5 min、气腹毕和术毕的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SPO_2)、呼之睁眼时间、拔管时间和清醒程度及不良反应。结果:2组患者拔管时间和清醒程度均无显著性差异;试验组镇静评分(OAAS评分)明显高于对照组(P＜0．05);对照组在气腹后5min的HR,SBP,DBP及气腹后5min、气腹结束、术毕的HR显著高于麻醉诱导前的基础值(P＜0．05),试验组术中无明显变化;气腹后5min、气腹结束及术毕对照组的HR和SBP均明显高于试验组(P＜0．05);气腹后5min、气腹结束时对照组的DBP明显高于试验组(P＜0．05);试验组的术后恶心呕吐发生率显著低于对照组(P＜0．05)。结论:与常规静吸复合麻醉下行LC手术比较,丙泊酚复合瑞芬太尼全凭静脉麻醉围术期麻醉更平稳,并发症较少。Objective： To compare the effects and safety of anesthesia with intravenous infusion of remifentanil-propofol versus isoflurane inhalation. Methods：Forty patients undergoing elective laparoscopic cholecystectomy were randomly 1 ： 1 assigned to one of two anesthesia maintenance groups ： intravenous infusion with combination of remifentanil （0.5μg·kg^-1·min^-1） with propofol （6 mg·kg^-1 · h^-1 ） or inhalation with 2% isoflurance. The induced anesthesia was performed with midazolam 0.1 mg. kg 1, propofol 2 mg·kg^-1, remifentanil 2μg·kg^-1 and vecuronium 0.1 mg·kg^-1in both groups. The anesthetic efficacy of the two groups was evaluated based on the SBP, DBP, HR and SPO2 patients experienced before anesthesia, before pneumoperitoneum, at 5 min after pneumoperitoneum, at the end of pneumoperitoneum and at the end of operation. Other efficacy objectives included the time of endotracheal extubation, OAAS score after extubation, pain and consciousness during operation, adverse events after operation. Results： No significant differences in the time of endotracheal extubation and consciousness during the operation were found. The anesthesia-injected patients had higher OAAS scores after extubationa than anesthesia-inhaled patients （P 〈 0.05 ）. Compared to the pre-anesthetic baseline, the SBP, DBP and HR at 5 min after pneumoperitoneum, at the end of pneumoperitoneum and at the end of operation showed higher values in the inhalation group （P 〈 0.05 ）. No significant differences in the SBP, DPB and HR were found pre- and post-anesthetic treatment in the anesthesia-injected patients. The inhaled patients experienced significantly higher SBP, DBP and HR at 5 min after pneumoperitoneum, at the end of pneumoperitoneum and at the end of operation than the anesthesia-injected patients （P 〈 0.05）. The common adverse events were nausea and vomiting, which had more incidences in the inhaled patients than the anesthesia-injected patients after operation （P 〈 0. 05）. Conclusion ： The

关 键 词：丙泊酚 瑞芬太尼 全凭静脉麻醉 腹腔镜胆囊切除术 

分 类 号：R971.2[医药卫生—药品] R969.4[医药卫生—药学]