腹腔镜手术不同麻醉方法苏醒质量的比较  

Comparison of awakening quality with different anesthesia on laparoscopic surgery

作　　者：鲁爱民[1] 任俏[1] 

机构地区：[1]深圳市第五人民医院麻醉科,广东深圳518001

出　　处：《疾病监测与控制》2014年第5期283-285,共3页Journal of Diseases Monitor and Control

摘　　要：目的在腹腔镜手术中用不同的麻醉方法和不同的麻醉管理手段对比研究其各自的苏醒质量。方法 80例择期腹腔镜手术患者,ASAⅠ～Ⅱ级,随机分为4组。对照组与A组分别单纯吸入异氟醚和七氟醚,浓度2%～3%,氧流量3L/min。B组吸入七氟醚1%～2%同时微量泵持续输注瑞芬太尼0.1～0.2μg·kg﹣1·min﹣1。C组微量泵持续输注丙泊酚6～8mg·kg﹣1·h﹣1、瑞芬太尼0.2μg·kg﹣1·min﹣1。对照组采用脑电双频指数(bispectral index,BIS)监测,术中BIS的靶控值控制在45～50,术毕前15min逐渐降低吸入麻醉药浓度,使BIS值在手术结束时达到60。B组缝皮时停药,A、C两组在手术的最后15min逐渐调低麻醉药用量,至缝皮停药。结果 A、C两组气腹2min MAP较气腹前显著升高(P<0.05),C组气腹2min和气腹30min MAP较其余三组相同时点显著升高(P<0.05),A组气腹2min和气腹30min MAP高于B组和对照组,但差异并无统计学意义。B组气腹30min与C组气腹前、气腹30min HR较其余各组相同时点显著降低(P<0.05),B、C两组气腹30min HR较术前显著降低(P<0.05)。各组呼吸恢复时间、睁眼时间和拔管时间差异无统计学意义,拔管时、拔管后15min以及30min OAA∕S评分差异无统计学意义。结论手术后期滴定法调整用药以及采用平衡麻醉,均能获得采用BIS监测指导用药同样良好的苏醒效果。Objective The comparison of awakening quality with different anesthesia and intraoperative management on laparoscepic surgery. Methods 80 patients who were categorized between ASAI-II were divided into 4 groups randomly underwent selective laparoscopic surgery. The control group used isoflurane, while Group A using sevoflurane, both of with had a concentration of 2%~3% and oxygen flow at 3L/min. Group C used sevoflurane at a concentration of 1%-2% and remifentanil 0.1.4）.2ug.kg l.min i constantly being infused via micropump. Group D was constantly injected propofol 6-8mg-kg - l-h - land remifentanil 0.2ug.kg- 1min- 1 via micropump. The control Group adopted bispectral index （BIS） monitoring of which the target value was controlled at 45-50, and reaching 60 when surgery end by decreasing the concentration of inhaled anesthetics fifteen minutes before the end of surgery. Group B ceases inhaled anesthetics when skin is being stitched, group A and C reduced surgical anesthetic gradually in the last fiReen minutes and ceases when skin suiture started. Results MAP at two-minute of Group A and C increased significantly than before pneumoperitoneum （P〈0.05）. MAP at two-minute and thirty-minute after pneumoperitoneum of Group C arc significantly higher than at the same time of the other three groups （P〈0.05）. MAP at two-minute and thirty-minute after pneumoperitoneum of Group A were higher than group B and control group, but was not statistically significant. HR of group C before pneumoperitoneum and 30-minute after pneumoperitoneum of both group B and C is much lower than the same time of the other groups （P〈0.05）. HR of group B and C at 30-minute after pneumoperitoneum decreased significantly than preoperative status. Each group＇s breathing recovery time, eye opening time and extubation time were of no significant differences. OAA/S scores had no statistically difference between extubatiun, 15 minutes after extubation and thirty minutes after extubation. Conclusion Medication guided with BIS mo

关 键 词：腹腔镜 静脉麻醉 吸入麻醉 苏醒质量 

分 类 号：R614.1[医药卫生—麻醉学]