不同诱导剂量环泊酚复合瑞芬太尼在肥胖并胆囊结石腹腔镜术中的效果及安全性比较  

Comparison of the Effects and Safety of Different Induction Doses of Propofol Combined with Remifentanil in Obese Patients with Cholecystolithiasis Undergoing Laparoscopic Surgery

作　　者：王丽丽[1] 王帅 WANG Lili;WANG Shuai(The Third People's Hospital of Zhengzhou,Zhengzhou Henan 460000,China)

机构地区：[1]郑州市第三人民医院,河南郑州460000

出　　处：《药品评价》2024年第2期232-237,共6页Drug Evaluation

摘　　要：目的 比较不同诱导剂量环泊酚复合瑞芬太尼在肥胖并胆囊结石腹腔镜术中的效果及安全性。方法 选取2020年6月至2023年6月于郑州市第三人民医院行胆囊结石腹腔镜术的172例肥胖患者,体质量指数(BMI)≥28 kg/m2,经计算机随机数字生成表分为A组、B组、C组、D组,各43例,分别以0.3、0.4、0.5、0.6 mg/kg环泊酚复合瑞芬太尼0.5~1 μg/kg行麻醉诱导。比较四组术中麻醉药物用量、麻醉诱导时间、手术情况、麻醉恢复时间、麻醉效果,T_(0)(入室前)、T_(1)(麻醉诱导开始时)、T_(2)(气管插管时)、T_(3)(手术结束时)血流动力学指标及不良反应。结果 四组瑞芬太尼、舒芬太尼、罗库溴铵、丙泊酚用量比较,差异无统计学意义(P>0.05)。与A组比较,B组、C组、D组麻醉诱导时间缩短(P<0.05);与A组、B组比较,C组、D组麻醉苏醒时间、自主呼吸恢复时间、拔管时间延长(P<0.05),与C组比较,D组麻醉苏醒时间、自主呼吸恢复时间、拔管时间延长(P<0.05)。组间:与A组、B组比较,T_(1)时C组、D组平均动脉压(MAP)、心率(HR)均降低(P<0.05),T_(2)、T_(3)时C组、D组MAP、HR均升高(P<0.05),与C组比较,T_(1)时D组MAP、HR均降低(P<0.05),T_(2)、T_(3)时D组MAP、HR均升高(P<0.05)。组内:与T_(0)时比较,T_(1)时四组MAP、HR均降低(P<0.05),T_(2)时四组MAP、HR均升高(P<0.05),T_(3)时C组、D组MAP、HR均升高(P<0.05);与T_(1)时比较,T_(2)、T_(3)时四组MAP、HR均升高(P<0.05);与T_(2)时比较,T_(3)时四组MAP、HR均降低(P<0.05)。与A组比较,B组、C组、D组麻醉效果I级构成比升高,II级构成比降低(P<0.05)。与A组、B组、C组比较,D组气道阻塞、心动过缓发生率升高(P<0.05)。结论 0.4、0.5、0.6 mg/kg环泊酚复合瑞芬太尼在肥胖并胆囊结石腹腔镜术中的镇静效果优于0.3 mg/kg,0.3、0.4 mg/kg环泊酚麻醉恢复时间短于0.5、0.6 mg/kg,血流动力学更为平稳,不良反应少,综合考虑0.4 mg/kg环泊酚复合瑞芬�Objective To compare the effects and safety of different induction doses of propofol combined with remifentanil in obese patients with cholecystolithiasis undergoing laparoscopic surgery.Methods A total of 172 obese patients with body 2 mass index(BMI)≥28 kg/m who underwent laparoscopic surgery for cholecystolithiasis in The Third People's Hospital of Zhengzhou from June 2020 to June 2023 were enrolled and randomly divided into group A,B,C,and D by a computer-generated random number table,with 43 cases in each group.They were induced with propofol 0.3,0.4,0.5,and 0.6 mg/kg combined with remifentanil 0.5-1μg/kg,respectively.The anesthetic drug consumption,anesthetic induction time,surgical situation,anesthetic recovery time,anesthetic effect,hemodynamic parameters at T_(0)(before entry),T_(1)(at the beginning of anesthesia induction),T_(2)(at the end of endotracheal intubation),T_(3)(at the end of surgery)and adverse reactions were compared among the four groups.Results There were no significant differences in the consumption of remifentanil,sufentanil,rocuronium and propofol among the four groups(P>0.05).Compared with group A,the anesthetic induction time was shortened in group B,C and D(P<0.05).Compared with group A and B,the anesthetic recovery time and spontaneous breathing recovery time,extubation time were prolonged in group C and D(P<0.05),and compared with group C,the anesthetic recovery time and spontaneous breathing recovery time,extubation time were prolonged in group D(P<0.05).Among the groups:compared with group A and B,mean arterial pressure(MAP)and heart rate(HR)were decreased in group C and D at T_(1),and increased at T_(2) and T_(3)(P<0.05);compared with group C,MAP and HR were decreased in group D at T_(1),and increased at T_(2) and T_(3)(P<0.05).In the same group:compared with T_(0),MAP and HR were decreased in all four groups at T_(1)(P<0.05),and increased at T_(2)(P<0.05),MAP and HR were increased in group C and D at T_(3)(P<0.05);compared with T_(1),MAP and HR were increased in all four gr

关 键 词：肥胖 胆囊结石腹腔镜术 环泊酚 瑞芬太尼 安全性 

分 类 号：R614[医药卫生—麻醉学]