靶控输注丙泊酚和瑞芬太尼时Proseal喉罩用于老年病人腹腔镜手术临床观察

目的:观察靶控输注丙泊酚和瑞芬太尼时Proseal喉罩用于老年病人腹腔镜手术时的临床应用价值。方法:选择ASAⅠ~Ⅱ级、年龄≥65岁行腹腔镜胆囊切除手术老年病人80例,随机分为两组,每组40例。PLMA组为靶控输注喉罩组(A组),ET组为气静复合气管插管组(B组)。记录两组患者诱导前、诱导后、插管(罩)即刻、插管(罩)后1min、插管(罩)后3 min、拔管(罩)后1 min和拔管(罩)后3min时的平均动脉压(MAP)和心率(HR)变化。记录两组病人苏醒时间、拔管(罩)时间、置管(罩)成功率。记录两组病人拔管时呛咳反应、术后24 h咽痛、声嘶、咳嗽的发生率。结果:PLMA组病人的苏醒时间、拔管(罩)时间明显短于ET组,差异有统计学意义;PLMA组病人插喉罩即刻、插喉罩后1 min及拔喉罩后1 min和3 min病人的HR、MAP无明显变化,与诱导前相比变化无统计学意义(P>0.05);ET组插管即刻、插管后1 min及拔管后1 min和3 min病人的HR、MAP显著升高,与诱导前相比差异有统计学意义(P<0.01)。ET组拔管时有60%病人出现呛咳反应,而PLMA组只有10%,两组相比P<0.01;ET组术后24 h咽痛、声嘶、咳嗽的发生率明显高于PLMA组。结论:靶控输注丙泊酚和瑞芬太尼时Proseal喉罩用于老年病人腹腔镜手术操作简单、插管刺激小、血流动力学平稳、术毕清醒快、拔管早、术后并发症少,是老年病人微创手术比较理想的麻醉选择。在使用喉罩时丙泊酚血浆靶浓度(Ctpro)2.0μg/ml+瑞芬太尼血浆靶浓度(CtR)5.0 ng/ml能获得满意的血流动力学效果。

Clinical observation on target controlled infusion of propofol and remifentanil by ProSeal laryngeal mask airway in the elderly patients undergoing laparoscopic cholecystectomy

Objective：To evaluate the clinical effect of target controlled infusion（TCI; open-loop system） of propofol and remifentanil by ProSeal laryngeal mask airway （PLMA） in the elderly patients undergoing laparoscopic cholecystectomy（LC）. Methods ： Eighty patients（ ASA Ⅰ -- Ⅱ ） aged 965 years were evenly randomized into two groups. Group A received the anesthesia with TCI by PLMA and group B underwent combined general anesthesia with endotracheal tube and mask. The changes of MAP and HR in the two groups were monitored in terms of pre-induction,post-induction, the moment of intubation or wearing the mask, 1 or 3 rain after intubation or wearing the mask, 1 or 3 min after removal of the tube or mask, respectively. The records were also registered in emergence of palinesthesia, consumption of extubation or removal of the mask and accomplishment of intubation or wearing the mask at a single time besides the chocking at extubation and complications such as pharyngodynia, hoarse voice and coughing 24 h after the operation in the two groups. Results： Emergence of palinesthesia and extubation time in group A took much less than group B（ P〈 0.01 ）. HR and MAP in group A showed no obvious change with regard to the moment of intubation, lmin after the intubation and 1 or 3 min after the re moval of the tube or mask airway as cornpared with pre-induction（ P 〉 0.05）. But HR and MAP increased significantly in group B concerning the data described in group A when compared with pre-induction, which had statistical difference （ P 〈 0.01 ）.. The chocking at extubation was observed in 60% of patients in group B vs 10% in group A（P〈0.01 ）. Complications such as pharyngodynia, hoarse voice and coughing were much higher in group B than that of group A. Conclusion ：TCI of propo- fol and remifentanil with PLMA in elderly patients undergoing LC is preferable in this minimally invasive procedure thanks to the easy mare agement, reduced response to intubation, balanced hemodynamics, quick emer