靶控输注异丙酚复合瑞芬太尼在老年人腹腔镜胆囊切除术的应用  

The application of target-controlled infusion with remifentanil and propofol in the elder laparoscopic cholecystectomy

作　　者：黎达锋 张声笋 叶嘉梅 

机构地区：[1]广东省阳江市人民医院麻醉科,529500

出　　处：《中国实用医药》2010年第6期33-35,共3页China Practical Medicine

摘　　要：目的探讨异丙酚复合瑞芬太尼靶控输注(TCI)全凭静脉麻醉用于老年人腹腔镜胆囊切除术(LC)的可行性及安全性。方法择期LC手术老年患者56例,美国麻醉医师协会(ASA)分级I-Ⅱ级,年龄60～81岁,心肺功能正常,随机等分为静吸麻醉组(I组)和静脉全麻组(T组)各28例。I组以异丙酚、瑞芬太尼、阿曲库铵诱导后做气管插管,术中吸入1%～2.5%异氟醚维持麻醉。T组瑞芬太尼和异丙酚靶控输注,术中根据血压、心率调整靶浓度。术中监测HR、SBP、DBP、MAP等指标及记录手术结束至自主呼吸、睁眼、拔除气管导管、恢复定向能力的时间。结果两组间的拔管时间、清醒程度有显著差异。静吸麻醉组(I组)在气腹后5min的HR、SBP、MBP明显高于术前基础值(P<0.05或P<0.01)。而T组术中无明显变化,术后恶心呕吐发生率也明显低于I组。结论异丙酚复合瑞芬太尼靶控输注静脉麻醉用于老年人LC手术可达满意的麻醉深度,具有苏醒快,围术期血压、心率变化幅度小,能降低术后恶心呕吐的发生,且无吸入麻醉药的手术室空气污染等优点,优于传统的静吸复合麻醉。Objective To investigate the feasibility and security of target-controlled infusion with remifentanil and propofol to the elder laparoscopic cholecystectomy. Methods Fifty-six elder LC surgery patients whose age were 60 ～ 81 years old were selected. Graded Ⅰ-Ⅱ of American Society of Anesthesiologjsts （ASA）,and they were randomly divided into the inhalation anesthesia group （I-group） and intravenous anesthesia group （T-group）,with 28 cases each. After the inducement with propofol、remifentanil、atracurium,then the I-group was made the trachea intubatton,and inbreathed the isoflurane with 1% ～ 2. 5% to keep the efficacy of the anaesthesia. T-group was used fentanyl and propofol to make the Target-controlled infusion（ TCI）. The concentration was adjusted with blood pressure and heart rate. The indicators of HR、SBP、DBP、MAP were monitored continuously in two groups during operation,and the time of breathing on his own,eyes-opening,extubation,recovery directional capability were recorded after the end of the surgery. Results There were significant differences in extubation time and awake extent in the two groups. The HR、SBP、MBP of pneumoperitoneum after 5 minutes were much higher than that of preoperative in I-group（P〈0. 05 or P〈0. 01）,while there was no obvious change in T-group. The induction time and incidence of nausea and vomiting was also much less in T-group than those in I-group after surgery. Conclusions Target-controlled infusion with remifentanil and propofol to the elder laparoscopic cholecystectomy can get satisfied depth of anesthesia,and the recovery is better. The extent of the blood pressure and the heart rate is narrow during the perioperative period,and it can reduce the probability of nausea and vomiting after the operation,and there is no air pollution in the operating room by reason of no inhaling the anesthetics. So the anaesthesia maintained by propofol target-controlled infusion for lapamscopic choleeystectomy is better than that by general anesthesia

关 键 词：瑞芬太尼 异丙酚 靶控输注 腹腔镜胆囊切除术 老年人 

分 类 号：R614[医药卫生—麻醉学]