瑞芬太尼-丙泊酚靶控输注全麻下腹腔镜胆囊手术的血流动力学变化

目的:观察瑞芬太尼-丙泊酚靶控输注全麻下腹腔镜胆囊切除术中的血流动力学变化。方法:18例择期腹腔镜胆囊切除术患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级I-II级,入室后即行外周动脉心排量监测,以瑞芬太尼-丙泊酚靶控输注复合芬太尼诱导并维持麻醉至手术结束。分别记录手术期间10个时点的心率(HR),平均动脉压(MAP),收缩压(SBP),舒张压(DBP)和外周动脉心功能指数(APCI)。结果:气腹建立后即刻HR增快,DBP升高,APCI明显下降(P<0.05),5min后,DBP进一步升高(P<0.05),SBP、MAP及APCI逐步恢复至气腹前水平且保持相对稳定。气腹解除后即刻HR减慢、DBP降低和APCI升高(P<0.05);5min后MAP、DBP下降(P<0.05),但仍较气腹前高,而HR及APCI恢复气腹前水平。结论:瑞芬太尼-丙泊酚靶控输注全麻下腹腔镜胆囊切除术中,除气腹建立及解除短时间内血流动力学变化较明显外,术中整体血流动力学维持平稳。

Hemodynamic Changes During Remifentanil-Propofol Anesthesia for Laparoscopic Cholecystectomy

Objective：To observe the hemodynamic changes during remifentanil-propofol anesthesia for laparoscopic cholecys- tectomy. Methods：Eighteen patients （ASA I-II） scheduled for laparoscopic cholecystectomy were included in this study. After entering operation room, patients were monitored by arterial pressure based cardiac output measurement device. Patients were induced and maintained anesthesia with remifentanil-propofol target controlled infusion system. Heart rate （HR）, mean arterial pressure （MAP）, systolic blood pressure （SBP）, diastolic blood pressure（DBP） and arterial pressure-based cardiac index （AP CI） were recorded at 10 different time points during the surgery. Results： After CO2 insufflation, HR and DBP increased, AP- CI decreased （P〈0.05）. 5 minutes later, DBP increased further, SBP, MAP and APCI recovered to previous level gradually and kept stable. After exsufflation, HR and DBP decreased, APCI increased （P〈0.05）. After pneumoperitoneum was re- moved 5 minutes, MAP and DBP decreased （P〈0.05）, but they were still higher than the levels before peritoneal insufflation. HR and APCI returned to the levels before peritoneal insuffiation. Conclusion： During the process of remifentanil propofol an- esthesia for laparoscopic cholecysteetomy, the hemodynamie parameters keep stable, except during the short time after perito- neal insufflation and exsufflation.