七氟烷复合瑞芬太尼用于腹腔镜胆囊切除手术麻醉的临床观察

目的 观察七氟烷复合瑞芬太尼用于腹腔镜胆囊切除手术的麻醉效果。方法60例美国麻醉学会手术前分级（ASA）Ⅰ-Ⅱ级拟行腹腔镜胆囊切除手术的成年患者，随机分成七氟烷组和对照组。各组30例，术前用药，麻醉诱导相同。麻醉维持：七氟烷组全程吸入七氟烷，浓度2％-4％，对照组持续静脉泵入丙泊酚6—10mg／（kg·h），两组均在麻醉诱导后静脉泵入瑞芬太尼0．05—0．40μg／（kg·min）辅助麻醉，术中根据生体征变化和手术刺激强度调控麻醉深度。观察术中生命体征变化、麻醉效果、苏醒时间、苏醒程度和不良反应。结果两组麻醉效果满意，术中血压、心率改变比较无明显差异。七氟烷组瑞芬太尼输注速率和总量明显低于对照组（P〈0．05），两组苏醒时间和苏醒程度评分无显著差异（P〉0．05）。结论七氟烷复合瑞芬太尼静吸麻醉效果好，术中循环稳定、苏醒快捷，是腹腔镜胆囊切除手术理想的麻醉方法。

Clinical observation on sevoflurane and remifentanil applied for anesthesia in laparoscopic cholecystotomy

Objective To evaluate the anesthetic effect of sevoflurane combined with remifentanil in laparoscopic cholecystotomy. Methods 60 patients with the classification of American Society of Anesthesiologists at gradeⅠ or Ⅱ undergone laparoscopic cholecystotomy were randomly divided into sevoflurane group and control group, 30 patients in each group. The preoperative medication and anesthesia induction of patients in these two groups were similar. In sevoflurane group, the anesthesia was maintained by inhalation of sevoflurane （2% - 4% ） during the operation; and in control group, the anesthesia was maintained by intravenous infusion of propofol 6 - 10 mg/（ kg·h） during the operation. After anesthesia induction, intravenous infusion of remifentanil 0.05 - 0.40 μg/（ kg · mim） were used for assistant anesthesia in patients of these two groups. The depth of anesthesia was adjusted according to change of vital signs and operative stimulation. The changes of vital signs, anesthetic effect, interval before revival, degree of revival and untoward effects during the operation were observed. Results The anesthetic effect in these two groups was excellent. The changes in blood pressure and heart rate between these two groups showed no significant difference. In sevoflurane group, the speed of infusion and total dosage of remifentanil were significantly lower than those of control group （ P 〈 0.05 ）. The difference in interval before revival and degree of revival between these two groups showed no statistical significance （ P 〉 0.05）. Conclusion sevoflurane combined with remifentanil showed excellent anesthetic effect. It can provide stable circulation during operation and make the interval before revival getting shorter. So it can be taken as a perfect anesthetic method in laparoscopic cholecystotomy.