靶控输注丙泊酚复合芬太尼静脉麻醉在老年患者腹腔镜切除术中的应用

目的:比较TC I输注丙泊酚复合芬太尼静脉麻醉与静吸复合全麻在老年患者腹腔镜手术中血液动力学的改变。方法:选择择期进行腹腔镜胆囊切除术(LC)60岁以上的患者60例,ASAⅠ~Ⅱ级,随机分为TC I(A)组和静吸复合(B)组,每组各30例。A组采用TC I丙泊酚复合芬太尼静脉麻醉,B组采用静脉复合吸入异氟醚维持麻醉。分别于各时点记录患者的HR、SBP、DBP、PETCO2。结果:A、B两组患者各时点PETCO2逐渐增加,T2、T3时与T0时相比差异有显著性(P<0.01)。组间比较各时点差异无显著性。A组SBP最低下降了21%,B组则最低下降了40%,两者比较有显著性差异(P<0.05);DBP则A、B两组分别下降了18%和20%。TC I丙泊酚A组的血压波动明显小于静吸复合B组。A组的HR由(77.4±9.5)次/分下降至(70.6±7.7)次/分,下降了10%;B组的HR由(82.4±14.6)次/分降至(61.0±4.4)次/分,下降了25%。组间相比有显著性差异(P<0.05)。结论:靶控输注能够很好的抑制应激反应,维持血液动力学的稳定。

Application of target controlled infusion (TCI) of propofol and fentanyl in the elderly patients undergoing lapsroscopic surgery

Objective: To compare the effects of different anaesthesia such as intravenous target-controlled infusion(TCl) of propofol in combination of fentanyl and combined intravenous inhalation anesthesia on hemodynamic response in the elderly patients undergoing laparoscopic surgery.Methods:Sixty ASA Ⅰ-Ⅱ patients aged > 60 y undergoing elective laparoscopic cholecystectomy were randomly divided into two groups:group A underwent intravenous TCI of propofol and fentanyl(n=30)and group B undcrwent combined intravenous inhalation anesthesia(n=30).HR? SB? DBP and P_(ET)CO_2 were memorized on every prearranged point.Results:P_(ET)CO_2 of the patients increased gradually in group A and B,and significant difference was found on T_2? T_3 point when compared with point T_0(P<0.0 1),and there was either no significant difference in P_(ET)CO_2 among group A and B.The most decrease of SBP in group A was 21% and 40% in group B,and there existed prominent difference between group A and B(P<0.05).DBP reduced 18% and 20% in group A and B.The undulation of blood pressure in group A was significantly less than group B.HR in group A decreascd by 10% from(77.4±9.5) to (70.6±7.7),HR in group B decreased by 25% from(82.4±14.6) to(61.0±4.4).There was significant difference between group A and B in HR.Conclusions: Target-controlled infusion(TCI) restrains stress response prominently and maintains the stabilization of hemodynamic response effectively.