雷米芬太尼-七氟醚静吸复合全麻在腹腔镜手术的应用  

Application of remifentanil combined with sevoflurane anesthesia in laparoscopic operation

作　　者：徐洁[1] 徐福涛[1] 周路阳[1] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《临床麻醉学杂志》2007年第10期827-829,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察雷米芬太尼-七氟醚静吸复合全麻在腹腔镜手术的应用中对血流动力学的影响。方法35例全麻下腹腔镜胆囊或妇产科手术病人,男6例,女29例,ASAⅠ或Ⅱ级,以雷米芬太尼1μg/kg、咪唑安定2～3mg、丙泊酚1～2mg/kg、维库溴铵8mg作麻醉诱导后气管插管;麻醉维持为雷米芬太尼0.2μg·kg-1·min-1、丙泊酚2mg·kg-1·min-1微量输注泵恒速输入,吸入1%～2%七氟醚,间断追加维库溴铵4mg。记录诱导前后血流动力学变化。结果注入雷米芬太尼后BP和HR明显下降,注入丙泊酚后进一步下降,气管插管后明显回升,切皮时较插管后下降。气腹后CO、每搏量(SV)和心脏指数(CI)均明显下降;随后逐步回升,放气后恢复或高于基础水平。结论雷米芬太尼和七氟醚均起效快、作用时间短,无蓄积,适用于腹腔镜下的短小手术。Objective To investigate the effects of remifentanil combined with sevoflurane on hemodynamics in patients undergoing laparoscopic operation. Methods Thirty-five cases （ASA Ⅰ or Ⅱ ,male 6, female 29） undergoing laparoscopic cholecystectomy or gynecology surgery were induced with remifentanil 1.0 μg/kg, midazolame 2-3 mg, propofol 1-2 mg/kg, vecuronium 8 mg, and maintained with remifentanil 0.2 μg · kg^-1· min^-1, propofol 2 mg · kg^-1· min^-1 and 1%-2% sevoflurane inhalation. The hemodynamics were recorded before and during anesthesia. Results There was a significant decrease in BP, HR after remifentanil injection, even more after propofol. BP and HR were increased markedly after intubation and decreased significantly during skin incision. CO,SV and CI were decreased significantly after pneumoperitoneum and returned or even higher than the basic levels after deflation. Conclusion The short action and rapid recovery characteristics of remifentanil combined with srvoflurane anesthesia is suitable for laparoscopic operation.

关 键 词：雷米芬太尼 七氟醚 腹腔镜手术 血流动力学 

分 类 号：R614[医药卫生—麻醉学]