瑞芬太尼复合硬膜外麻醉在腹腔镜胆囊切除术中的应用体会  

The Application of Remifentanil and Epidural Hematoma in Laparoscopic Cholecystectomy

作　　者：顾其军[1] 任元华 黄利冲[1] 

机构地区：[1]四川省广元市第二人民医院麻醉科 [2]四川省广元市第一人民医院麻醉科,四川广元628017

出　　处：《中国现代医生》2007年第10Z期5-6,共2页China Modern Doctor

摘　　要：目的观察瑞芬太尼复合硬膜外麻醉下行腹腔镜胆囊切除术的安全性和有效性。方法随机选择40例无硬膜外麻醉禁忌症及穿刺困难,择期行腹腔镜胆囊切除术病人,ASAⅠ～Ⅲ级。行T8～9或T9～10间隙穿刺,硬膜外给予1%利多卡因+0.375%布比卡因混合液,麻醉平面控制在T4～12;开始气腹前10min以4μg/(kg·h)输注瑞芬太尼,气腹开始后根据情况以4～1μg/(kg·h)速度维持。记录不同时间点的血压,心率,SPO2变化。结果40例患者均顺利完成手术,硬膜外麻醉后15min,气腹后及手术结束时,所有患者SBP,DBP均有明显下降,且有显著性差异,以气腹开始1min内血压变化最大;HR在硬膜外麻醉后15min有所下降,以气腹开始1min内下降幅度最大,与基础值相比有显著性差异。给予麻黄碱后可以纠正血压和心率下降。SPO2在各时间点没有明显变化。结论只要硬膜外麻醉阻滞完善,术中重视麻醉管理,瑞芬太尼复合硬膜外麻醉下行腹腔镜胆囊切除术是安全可行的。Objective To observe the safety and validity of remifentanil and epidural hematoma in laparoscopic cholecystectomy. Methods 40 cases without taboo of anesthesia and difllcuhy of objection were operated with laparoseopic cholecystectomy. ASA Ⅰ～Ⅲ. They were injected in the gap of T（8-9） or （9-10） and the mixture of xylocaine （1%） and bupivaeaine （0.375%）. The level of anesthesia was T（4-12）. Remifentani was injected in the 10 minutes before pneumoperitoneum at the speed of 4 μ g/（kg· h） and kept at the speed of 4～1μg/（kg·h）. The BP,HR and SPO： at the different time weve recorded. Results 40 cases had the successful operation. Conclusion As long as we pay attention to the management of anesthesia,it is feasible and safe to use remifentanil and epidural hematoma in laparoscopic cholecystectomy.

关 键 词：瑞芬太尼 硬膜外麻醉 腹腔镜胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]