术中输注不同剂量雷米芬太尼对腹腔镜胆囊切除术患者应激反应的影响  

Effect of different doses of remifentanil infusion on stress responses in patients undergoing laparoscopic cholecystectomy

作　　者：杭东元[1] 顾达民[1] 盛良[1] 余露[1] 江文杰[1] HANG Dongyuan;GU Damin;SHENG Liang(Deimrtment o f Anesthesiology, Yixing People's Hospital,Yixing 21A200, CHINA)

机构地区：[1]宜兴市人民医院麻醉科

出　　处：《江苏医药》2019年第8期811-813,共3页Jiangsu Medical Journal

摘　　要：目的探讨腹腔镜胆囊切除术(LC)术中泵注不同剂量雷米芬太尼对应激反应的影响。方法全身麻醉下行LC患者60例随机均分为四组,术中分别持续泵注雷米芬太尼0.01μg·kg-1·min-1(A组)、0.05μg·kg-1·min-1(B组)、0.1μg·kg-1·min-1(C组)和生理盐水(D组)。于麻醉诱导前10 min(T0)、气腹15 min(T1)和术后30 min(T2)使用高效液相色谱法测定肾上腺素(E)和去甲肾上腺素(NE)浓度,放射性免疫分析法测定血浆皮质醇(Cor)浓度。计算四组患者的手术结束至拔管所用时间,记录皮肤瘙痒、低血压、恶心呕吐和苏醒期躁动等不良反应发生情况。结果 T1、T2时,A、B、C三组的血浆E和NE水平均较T0降低(P<0.05),B、C组低于A组(P<0.05),B、C组的血浆E和NE水平相仿(P>0.05)。T1、T2时,D组的血浆E和NE水平高于其他三组(P<0.05)。T1、T2时,A、B、D组患者的血浆Cor均较T0升高(P<0.05),B、C组的Cor水平均低于A、D组(P<0.05),但B、C组的Cor水平差异无统计学意义(P>0.05)。C组不良反应发生比例高于A、B、D组(P<0.05)。结论术中持续泵注雷米芬太尼0.05μg·kg-1·min-1能明显抑制LC患者的应激反应,剂量合适,不良反应少。Objective To investigate the effect of different doses of remifentanil infusion on the stress responses in the patients undergoing laparoscopic cholecystectomy(LC) under general anesthesia.Methods Sixty patients undergoing LC were randomly divided into four groups,who were intraoperatively infused remifentanil 0.01 μg·kg-1·min-1(group A), remifentanil 0.05 μg·kg-1·min-1(group B),remifentanil 0.1 μg·kg-1·min-1(group C),and normal saline(group D), respectively.Plasma levels of epinephrine(E),norepinephrine(NE) and cortisol(Cor) were measured with high efficiency liquid chromatography and radioimmunoanalysis at 10 minutes before induction of anesthesia(T0),15 minutes during pneumoperitoneum(T1),and 30 minutes after surgery(T2).The time from the end of surgery to extubation of the four groups was calculated.The adverse responses including skin itching,hypotension,nausea and vomiting,and agitation during recovery period were recorded in the four groups.Resluts At T1 and T2,plasma levels of E and NE in groups of A,B and C were all significantly lower than those at T0(P<0.05),which were lower in groups of B and C than those in group A(P<0.05),but were not significantly different between groups of B and C(P>0.05).At T1 and T2,plasma levels of E and NE in group D were higher than those in groups of A,B and C(P<0.05).At T1 and T2,plasma levels of Cor in groups of A,B and D were higher than those at T0(P<0.05),which were significantly lower in groups of B and C than those in groups of A and D(P<0.05),but were not significantly different between groups of B and C(P>0.05).The incidence of adverse responses of group C was significantly higher than that in groups of A,B and D(P<0.05).Conclusion Continuous infusion of remifentanil 0.05 μg·kg-1·min-1 during operation as a suitable dose could significantly inhibit the stress response in the patients undergoing LC with less adverse responses.

关 键 词：腹腔镜胆囊切除术 雷米芬太尼 应激反应 

分 类 号：R614[医药卫生—麻醉学]