地氟醚复合吗啡快通道麻醉在腹腔镜胆囊切除术的应用  

Application of fast track anesthesia with desflurane combined morphine in laparoscopic cholecystectomy

作　　者：沈宁[1] 叶柏波[1] 黎尚荣[1] 李晓芸[1] 刘辉[2] 

机构地区：[1]中山大学附属第三医院麻醉科,广州510630 [2]南方医科大学附属珠江医院麻醉科

出　　处：《中华普通外科学文献（电子版）》2011年第6期48-51,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：广东省自然科学基金(9151802904000014)

摘　　要：目的研究地氟醚复合吗啡快通道麻醉在腹腔镜胆囊切除术(LC)的应用。方法选择ASAⅠ-Ⅱ级LC患者90例,随机分为3组:P组(丙泊酚+瑞芬太尼)、S组(七氟醚+瑞芬太尼)和D组(地氟醚+吗啡),术前和诱导用药相同,麻醉维持:P组静脉输注丙泊酚、瑞芬太尼和顺式阿曲库铵;S组吸入七氟醚及静脉输注瑞芬太尼,不追加顺式阿曲库铵;D组吸入地氟醚及静脉注射吗啡,不追加顺式阿曲库铵。术中观察血流动力学波动情况和呼吸恢复、拔管、离室时间、术中知晓发生率以及苏醒期躁动评分。结果与P组比较,D组和S组的血压和心率波动例数减少(P<0.05);与P组和S组比较,D组呼吸恢复、拔管、离室的时间缩短(P<0.05),苏醒期躁动的评分较高(P<0.05)。3组患者均未出现术中知晓。结论地氟醚复合吗啡快通道麻醉应用于腹腔镜胆囊切除术对血流动力学波动影响小,术后苏醒速度快、质量高。Objective To study fast track anesthesia with desflurane combined morphine for laparoscopic eholecystectomy （LC）. Methods Ninety patients with ASA I - II grade underwent LC were randomly divided into three groups： group P （propofol ＋ remifentanil）, group S （sevoflurane ＋ remifentanil ） and group D （desflurane ＋ morphine）, treatment was the same in each groups before and induction of anesthesia, maintain of anesthesia： intravenous infusion of propofol, remifentanil and cisatracurium in group P ; inhalation of sevoflurane and intravenous infusion of remifentanil, no additional cisatracurium in group S ; inhalation of desflurane and intravenous injection of morphine, no additional cisatracurium in group. D. Intraoperative hemodynamic fluctuations and respiratory recovery, extubation time, the time away from PACU, the incidence of intraoperative awareness and restlessness score were assessed. Results The number of cases with blood pressure and heart rate fluctuations in group D and group S was significantly less than in group P （P 〈 0.05） ; the time of respiratory recovery and away from PACU in group D were less than group P and group S （P 〈 0.05）. There was no intraoperative awareness in each group the restlessness score in group D was better than group S and group P （P 〈 0.05）. Conclusion Fast track anesthesia with desflurane combined morphine in laparoscopic cholecystectomy can provide small hemodynamic fluctuations and high quality postoperative recovery to patients.

关 键 词：腹腔镜胆囊切除术 地氟醚 吗啡 快通道麻醉 

分 类 号：R614[医药卫生—麻醉学]