地氟醚复合吗啡快通道麻醉在腹腔镜胆囊切除术的应用

目的 研究地氟醚复合吗啡快通道麻醉在腹腔镜胆囊切除术（LC） 的应用.方法 选择ASAⅠ-Ⅱ级LC 患者90 例,随机分为3 组：P 组（丙泊酚＋ 瑞芬太尼）、S 组（七氟醚＋瑞芬太尼）和D 组（地氟醚＋ 吗啡）,术前和诱导用药相同,麻醉维持：P 组静脉输注丙泊酚、瑞芬太尼和顺式阿曲库铵;S 组吸入七氟醚及静脉输注瑞芬太尼,不追加顺式阿曲库铵;D 组吸入地氟醚及静脉注射吗啡,不追加顺式阿曲库铵.术中观察血流动力学波动情况和呼吸恢复、拔管、离室时间、术中知晓发生率以及苏醒期躁动评分.结果 与P 组比较,D 组和S 组的血压和心率波动例数减少（P 〈 0.05）;与P 组和S 组比较,D 组呼吸恢复、拔管、离室的时间缩短（P 〈 0.05）,苏醒期躁动的评分较高（P 〈 0.05）.3 组患者均未出现术中知晓.结论 地氟醚复合吗啡快通道麻醉应用于腹腔镜胆囊切除术对血流动力学波动影响小,术后苏醒速度快、质量高.

Application of fast track anesthesia with desflurane combined morphine in laparoscopiccholecystectomy

Objective To study fast track anesthesia with desflurane combined morphine for laparoscopic eholecystectomy （LC）. Methods Ninety patients with ASA I - II grade underwent LC were randomly divided into three groups： group P （propofol ＋ remifentanil）, group S （sevoflurane ＋ remifentanil ） and group D （desflurane ＋ morphine）, treatment was the same in each groups before and induction of anesthesia, maintain of anesthesia： intravenous infusion of propofol, remifentanil and cisatracurium in group P ; inhalation of sevoflurane and intravenous infusion of remifentanil, no additional cisatracurium in group S ; inhalation of desflurane and intravenous injection of morphine, no additional cisatracurium in group. D. Intraoperative hemodynamic fluctuations and respiratory recovery, extubation time, the time away from PACU, the incidence of intraoperative awareness and restlessness score were assessed. Results The number of cases with blood pressure and heart rate fluctuations in group D and group S was significantly less than in group P （P 〈 0.05） ; the time of respiratory recovery and away from PACU in group D were less than group P and group S （P 〈 0.05）. There was no intraoperative awareness in each group the restlessness score in group D was better than group S and group P （P 〈 0.05）. Conclusion Fast track anesthesia with desflurane combined morphine in laparoscopic cholecystectomy can provide small hemodynamic fluctuations and high quality postoperative recovery to patients.