七氟烷复合瑞芬太尼用于腹腔镜胆囊切除术的麻醉  

作　　者：李泉[1] 刘琴湘[1] 邵兵[1] 

机构地区：[1]广东省清远市人民医院暨南大学医学院第五附属医院麻醉科,511500

出　　处：《当代医学》2010年第18期67-68,共2页Contemporary Medicine

摘　　要：目的研究七氟烷复合瑞芬太尼在腹腔镜胆囊切除术(LC)麻醉中的应用及其效果评价。方法择期LC手术患者40例,随机等分为两组。两组均以咪达唑仑0.04mg/kg,丙泊酚1.5mg/kg,维库溴铵0.12mg/kg,芬太尼4μg/kg按顺序麻醉诱导后气管插管。麻醉维持:七氟烷组(S组)全程吸入七氟烷,吸入浓度2%～4%;对照组(C组)用微量泵持续静脉泵入丙泊酚6～10mg/(kg·h),两组均在麻醉诱导后静脉泵入瑞芬太尼0.05～0.3μg/(kg·min);术中根据生体征变化和手术刺激强度调控麻醉深度,按需给予维库溴胺0.05mg/kg维持肌松。记录麻醉诱导前、气腹前、气腹后5min、气腹毕和术毕的收缩压(SBP)、舒张压(DBP)、心率(HR)、呼之睁眼时间、拔管时间和清醒程度及不良反应。结果两组麻醉效果满意,术中血压、心率改变比较无明显差异(P>0.05);两组患者呼之睁眼时间、拔管时间、OAAS评分组间无明显差异(P>0.05)。结论七氟烷复合瑞芬太尼静吸麻醉效果好,术中血流动力学稳定、苏醒快捷,是腹腔镜胆囊切除手术理想的麻醉方法 。Objective To study the application of sevoflurane combined with remifentanil to larparoscopic cholecystectomy（LC） and to assess its usefulness in clinical practice.Methods Forty patients undergoing elective LC were randomly divided into sevoflurane group and control group,20 patients in each group.The induced anesthesia was performed with midazolam 0.04mg/kg propofol 1.5mg/kg,vecuronium 0.12 mg/kg and fentanyl 4μg/kg in both groups,In sevoflurane group,the anesthesia was maintained by inhalation of sevoflurane（2%～4%） during the operation;and in control group,the anesthesia was maintained by intravenous infusion of propofol 6～10 mg/（kg·h）during the operation.After anesthesia induction,intravenous infusion of remifentanil 0.05～0.3μg/（kg·min） were used for assistant anesthesia in patients of these two groups.The anesthetic efficacy of the two groups was evaluated based on the SBP,DBP and HR patients experienced before anesthesia,before pneumperitneum,at 5min after pneumoperitoneum,at the end of pneumperitneum 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 The anesthetic effect in these two groups was excellent.The changes in blood pressure and heart rate between these two groups showed no significant difference（P0.05）.The time from stopping administration of anesthetics until eye opening and tracheal extubation,OAAS score after extubation,pain and consciousness during operation and adverse events after operation between these two groups showed no significant difference（P0.05）.Conclusion Sevoflurane combined with remifentanil showed excellent anesthetic effect.It can provide stable hemodynamics during operation and make the interval before revival getting shorter.So it can be taken as a perfect anesthetic method in laparoscopic cholecystotomy.

关 键 词：七氟烷 瑞芬太尼 腹腔镜胆囊切除术 血流动力学 

分 类 号：R614[医药卫生—麻醉学]