丙泊酚和瑞芬太尼靶控输注在妇科腹腔镜术中的应用

目的：观察在妇科腹腔镜手术中采用丙泊酚和瑞芬太尼靶控输注（Target controlled infusion,TCI）的麻醉效果,并与吸入麻醉进行比较。方法：选择ASAⅠ～Ⅱ级择期行腹腔镜子宫肌瘤剜除术的病人40例,随机分为TCI组（T组）与吸入麻醉组（I组）,每组20例。记录麻醉诱导前、气腹后30分钟、术毕和拔出气管导管后3分钟时的收缩压（SBP）、舒张压（DBP）和心率（HR）;记录病人停药至清醒（呼唤病人睁眼）时间、拔管时间、手术时间。结果：T组病人围术期血压平稳,各个时点的SBP、DBP、HR与基础值相比差异无显著性（P〈0.05）,I组病人SBP、DBP、HR在气腹后30分钟及拔出气管导管后3分钟时明显高于基础值,差异有显著性（〈0.05）,在相应时间点明显高于T组病人,差异有显著性（P〈0.05）。I组病人清醒时间、拔管时间比T组长,差异有显著性（〈0.05）。结论：丙泊酚和瑞芬太尼靶控输注用于腹腔镜子宫肌瘤剜除术病人安全可行,可有效抑制手术刺激引起的应激反应,术中血流动力学稳定,苏醒迅速完全。

Application of propofol and remifentanil by target controlled infusion during gynecological laparoscopic operation by target controlled infusion

Objective：To observe the anaesthetic effect of propofol and remifentanil by target controlled infusion （TCI） used in gy- naecological laparoscopic operation, and to compare the anaesthetic effects of propofol and remifentanil with inhalation anesthesia.Methods： Forty cases arranged laparoseopic hysteromyoma surgery were selected and were all in grade ASA Ⅰ～Ⅱ and divided into group TCI （group T） and group inhalation anesthesia （group I） randomly with 20 cases in eaeh group. SBP, DBP and the change of HR were record- ed before induction of anesthesia,30min after carbon dioxide pneumoperitoneum,the end of operation and 3min after extubation. The awake time ,time of extubation and surgery time were recorded.Results：The hemodynamics were stable and there were no significant difference with respect to SBP,DBP and HR at all time points compared with baseline （P〉0.05） in group T. In group I,SBP,DBP and HR were increased significantly at 30min after carbon dioxide pneumoperitoneum and 3rain after extubation when compared with baseline （P〈 0.05） and were higher than those of group T （P〈0.05） at relevant time. The awake time and time of extubation of group I were obviously longer than those of group T （P〈0.05）.Conclusion：Propofol/remifentanil TCI-based anesthesia achieves the optimal hemdynamic stability during anesthesia maintance and better recovery profile from anesthesia, and TCI-based anesthesia suppressed the stress response in laparoscopic hysteromyoma surgery.