腹腔镜胆囊切除术瑞芬太尼-异丙酚全凭静脉麻醉与地氟醚静吸复合麻醉效果的比较  

Comparison of Total Intravenous Anesthesia of Remifentanil-Propofol with Intravenous Combined Desflurane Inhalation Anesthesia in Laparoscopic Cholecystectomy

作　　者：郑洪[1] 刘建华[1] 李李[1] 

机构地区：[1]中南大学湘雅二医院麻醉科,长沙410011

出　　处：《中国现代手术学杂志》2007年第1期63-65,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的比较腹腔镜胆囊切除术(laparascopic cholecystectomy,LC)瑞芬太尼-异丙酚全凭静脉麻醉与静吸复合麻醉的临床效果。方法择期LC手术40例,随机分为对照组和实验组,每组20例。麻醉维持,对照组用10%地氟醚吸入,实验组按异丙酚6 mg/(kg.h)和瑞芬太尼0.5μg/(kg.min)的速度用微量泵输入。记录麻醉诱导前(T0)、气腹前(T1)和气腹后10min(T2),气腹毕(T3),术毕(T4)的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SPO2)、呼之睁眼时间,拔管时间,清醒程度及不良反应。结果对照组T2、T3、T4时HR、T2时SBP及DBP均显著高于T0时基础值(P<0.05),实验组各时点指标无明显变化;两组比较对照组T2、T3、T4时HR、SBP及T2、T3时DBP均明显高于实验组(P<0.05);两组患者拔管时间,清醒程度均无显著性差异;实验组镇静评分(OAAS评分)明显高于对照组(P<0.05);实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比较,异丙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 of total intravenous anesthesia of remifentanil-propofol with intravenous combined desflurane inhalation anesthesia in laparoscopic cholecystectomy （LC）. Methods Forty patients underwent selective LC were randomized into experiment group （Group E） and control group （Group C）, with 20 for each. Anesthesia were maintained with remifentanil 0. 5μg/（ kg ·min） and propofol 6 rag/（ kg · h） continual intravenous infusion in Group E and 10% desflurane inhalation in Group C. SBP, DBP, HR and SPO2 were monitored at different time points ： before anesthesia （ T0 ）, before pneumoperitoneum （ T1 ）, at 10 minutes after pneumoperitoneum （ T2 ） , at the end of pneumoperitoneum （ T3 ） , and at the end of operation （ T4 ）. The endotracheal extubation time, OAAS score, conscious recovery, pain and unwell during operation ,complications as nausea and vomiting after operation were recorded. Results （ 1 ） HR of T2, T3, T4, SBP and DBP of T2 were higher remarkably than those of To in Group C （ P 〈 0. 05 ） , whereas no obvious variations in Group E. Compared with Group E, HR and SBP of T2, T3, T4 and DBP of T2, T3 were significantly higher in group C（ P 〈 0. 05 ）. （2）There was no significant difference in the extubation time and conscious recovery between two groups. OAAS scores after extubation were higher and the occurrence of postoperative nausea and vomiting was lower in Group E than those of Group C （P 〈 0. 05 ）. Conclusion Compared with intravenous anesthesia plus desflurane inhalation, total intravenous anesthesia of remifentanil-propofol could be more suitable in LC with stable hemodynamics, fast conscious recovery and less complications.

关 键 词：异丙酚 瑞芬太尼 麻醉 静脉 胆囊切除术 腹腔镜 

分 类 号：R614[医药卫生—麻醉学]