舒芬太尼与芬太尼在腹腔镜胆囊切除术全凭静脉麻醉中的应用比较

目的比较舒芬太尼与芬太尼在腹腔镜胆囊切除术（LC）全凭静脉麻醉中的插管和苏醒期的反应。方法选择拟行腹腔镜胆囊切除术的患者60例（男27例，女33例），ASAⅠ～Ⅱ级，年龄35—60（41．2±6．8）岁，体重45—70（61．5±5．9）kg，随机分成舒芬太尼组（S组）和芬太尼组（F组），每组30例。S组术中使用舒芬太尼0．3μg／（kg·h）泵人，F组术中使用芬太尼2μg／（kg·h）静脉注射。两组均以丙泊酚6—8mg／（kg·h）恒速泵入维持麻醉。手术结束前30min停止舒芬太尼或芬太尼，结束前10min停止丙泊酚输注。记录：（1）诱导前、诱导后、插管前、插管时的血压和心率；（2）丙泊酚的使用总量、苏醒时间、拔管时间、术后意识恢复评分；（3）术后疼痛的评分。结果（1）诱导前后的血压和心率变化幅度S组小于F组，插管前后的血压、心率变化也较F组小，差异有统计学显著意义（P〈0．05）；插管时的呛咳反应发生的比例较F组低，但差异无统计学意义；（2）丙泊酚的使用总量、苏醒时间、拔管时间、术后意识恢复评分两组比较差异均有统计学极显著意义（P〈0．01）；（3）术后疼痛的评分S组较F组低。结论舒芬太尼可以安全有效地应用于LC的全凭静脉麻醉，并且麻醉苏醒更平稳。

Comparison of total intravenous anaesthesia with propofol-sufentanil versus propofol-fentanyl in laparoscopic cholecystectomy

Objective To compare the reactions of induction and analepsia period between TIVA with propofol-sufentanil and TIVA with propofol-fentanyl in laparoscopic cholecystectomy. Methods Sixty ASA Ⅰ-Ⅱ patients （27male,33female） aged 35 - 60 （ 41.2 ± 6. 8 ） years, weighed 45 - 70 （ 61.5 ± 5.9 ） kg, undergoing laparoscopic cholecystectomy were divided randomly into group sufentanil （S, n = 30） and group fentanyl （F, n = 30）, group S receive sufentanil 0. 3 μg/（kg · h）, group F receive fentanyl 2μg/（kg · h） , which was stopped at 30 min before the end of operation. Each group given propofol 6 mg/（kg · h）, which was stopped at 10 min before the end of operation. Two groups were given PCIA. The following data were recorded and compared between the two groups：（ 1 ）The changes in BP and HR during tracheal intubation and induction; （2） Consumption of propofol,analepsia and extubation time, consciousness recovery and （3） VAS in postoperation. Results （ 1 ） During tracheal intubation and induction the changes of BP and HR were significantly greater in group F than that in group S（ P 〈0. 05 ） ; （2） Consumption of propofol was less in group S than that in group F（ P 〈 0. 01 ） ;（3） Analepsia and extubation time in group S was faster than those in group F （ P 〈 0.01 ） ; （4） Consciousness recovery and VAS after operation were significantly better in group S. Conclusion TIVA with propofol-sufentanil suits to laparoscopic cholecystectomy and recovery from anesthesia with propofol-sufentanil is faster and stabler than that with propofol-fentanyl.