丙泊酚靶控输注复合瑞芬太尼在喉罩通气下输尿管镜碎石术中的应用

目的：比较丙泊酚靶控输注复合不同剂量瑞芬太尼用于喉罩通气下输尿管镜碎石术的临床效果。方法：选择期行输尿管镜碎石术的患者，随机分为3组，每组20例，采用相同诱导置入喉罩，以丙泊酚效应室浓度2mg／L，复合不同剂量瑞芬太尼维持，记录心电图、平均动脉压、心率、氧饱和度和呼末二氧化碳分压变化、辅助用药、体动情况及自主呼吸恢复时间和唤醒的时间。结果：瑞芬太尼剂量为：0．1μg／（kg·min）时，术中心率、血压波动大，患者体动发生率高（50％）；0．2μg/（kg·min）时，术中心率、血压波动较小，术后患者苏醒较快；0．3μg/（kg·min）时，术中心率、血压抑制作用明显，术后患者苏醒时间较长。结论：丙泊酚靶控输注2mg／L复合瑞芬太尼0．2μg/（kg·min），是输尿管碎石手术的较佳配伍剂量。

Comparison of different dosages of remifentanil combination target controlled infusion propofol anesthesia for ureteroscopic lithotripsy with laryngeal mask airway ventilation

Objective： To compare the clinical anesthetic effects of remifentanil combination target controlled infusion propofol for ureteroscopic mask airway （LMA） ventilation. Methods： 60 ASA Ⅰ - Ⅱ selective patien three different dosages of lithotripsy under laryngeal ts,aged 28-65y,undergoing ureteroscopic lithotripsy were randomly assigned into three groups（n=20）. After intravenous quick induction and the insertion of a proper size LMA, anesthesia was maintained with target controlled infusion propofol 2 mg/L and one of the three dosages of remifentanil 0.1 μg/（kg·min） for group Ⅰ, 0.2 μg/（kg·min） for group Ⅱ ,and 0.3 μg/（kg· min） for group Ⅲ. ECG, MAP, HR, SpO2 and PetCO2 were continuously monitored and intraoperative aidmedication, extremity movement, spontaneously breathing recovery time and awakening time were recorded. Results： Each operation was accomplished without any intraoperative consciousness. Compared with group Ⅱ, patients in group Ⅰ had larger fluctuation of HR and MAP, longer recovery time, and the incidence of extremity movements was 50%that demanded higher dose of muscle relaxant. In group Ⅲ, 0.3 μg/（kg·min） remifentanil resulted in significant depression of HR and MAP, leading to the usage of higher dose of vasopressors and longer recovery time. Conclusion： Continuous infusion of remifentanil combination target controlled infusion propofol anesthesia with LMA ventilation is a reliable approach for ureteroscopic lithotripsy anesthesia. Arget controlled infusion propofol 2 mg/L ＋0.2 μg/（kg· min） remifentanit may be an adequate dosage.