瑞芬太尼联合异丙酚双靶控输注与七氟谜麻醉用于妇科腹腔镜手术的临床观察

目的:评价瑞芬太尼联合异丙酚双靶控输注静脉麻醉用于妇科腹腔镜手术的临床可行性,并与七氟谜吸入麻醉比较,为此类手术探讨更合理的麻醉方式。方法:80例ASAⅠ~Ⅱ级,择期行妇科腹腔镜手术患者随机分成两组。A组TCI组:设定瑞芬太尼血浆靶浓度4 ng/ml、异丙酚3μg/ml;B组持续吸入2.5%~3.5%七氟谜维持手术;观察气管插管、拔管时段的平均动脉压(MAP)和心率变化;手术结束停药至自主呼吸恢复、意识恢复、拔管的时间;术后30min的视觉模拟疼痛评分(VAS)和术后恶心、呕吐发生率、术中知晓情况。结果:A组各时点MAP、HR明显低于基础值及B组(P<0.05),B组各观察点MAP、HR明显高于基础值(P<0.05);自主呼吸恢复、意识恢复及拔管时间A组与B组无明显差异(P>0.05)。术后30 min的视觉模拟疼痛评分(VAS)比较,A组明显优于B组(P<0.05)。B组有6例出现恶心、呕吐,有1例发生术中知晓。结论:本研究示A组用于妇科腹腔镜手术效果更佳,并发症更少。

Clinical observation on remifentanil and propofol target-controlled infusion of intravenous anesthesia and anesthesia with sevoflurane on laparoscopically operations of gynecology

Objective To evaluate the clinical feasibility of the laparoscopically operations of gynecology（LA） through remifentanil and propofol target-controlled infusion of intravenous anesthesia and compare to anesthesia with sevoflurane,in order to search for a more rational style of anesthesia.Method Total 80 patients with ASA Ⅰ ~ Ⅱ,electived LA were randomly divided into two groups.Group A（TCI group）：Setting the target plasma concentration of remifentanil 4 ng/ml,propofol 3 μg/ml;group B：continuously exposed to 2.5%~3.5% sevoflurane to maintain the LA.The average arterial pressure（MAP） and heart rate for tracheal intubation and extubation were observed;The time of withdrawal end of surgery to recovery of spontaneous breathing and consciousness recovery and extubation were observed;The visual analogue pain score（VAS） 30 min after operation and postoperative nausea and vomiting,the incidence of intraoperative awareness situation were observed.Results MAP and HR of group A at each observed point were significantly lower than the baseline values and that of group B（P0.05）,MAP and HR of group B at the observed points were significantly higher than the baseline values（P0.05）;recovery of spontaneous breathing and consciousness recovery and extubation of group A and group B had no significant difference（P0.05）;from comparison of the visual analog pain score（VAS） 30 min after operation,group A was significantly better than group B（P0.05）.Six patients of group A had nausea and vomiting,1 case of group A had intraoperative awareness.Conclusion Anesthesia style in group A is better,with fewer complications.