呼吸功能不全患者腹腔镜手术的麻醉及管理

目的探讨呼吸功能不全患者行腹腔镜手术麻醉及管理。方法126例伴有呼吸功能不全的腹腔镜手术患者按照其麻醉方式的不同分为4组。A组42例，采用靶控输注丙泊酚联合瑞芬太尼麻醉；B组28例，采用单纯靶控输注丙泊酚麻醉；C组36例，采用静吸复合麻醉；D组20例，采用静脉泵入丙泊酚复合瑞芬太尼麻醉。比较各组气腹前、气腹后5min、气腹后25min、术毕时的生命体征、动脉血气分析结果、肺通气功能及麻醉后恢复情况。结果B组和D组的HR和MAP在气腹5min和25min后与气腹前相比差异显著（P〈0．05），A组和C组气腹后的HR和MAP较B组和D组有显著差异（P〈0．05）。各组的PCO，和PETCO2在气腹后均逐渐升高，与气腹前差异显著（P〈0．05），各组间无显著性差异。A组术后苏醒时间显著短于其他各组（P〈0．05），C组苏醒时间短于B组和D组（P〈0．05）；A组术后入住PACU及出现恶心、呕吐者的比例显著低于其他各组（P〈0．05）。结论靶控输注丙泊酚复合瑞芬太尼麻醉、静吸复合麻醉应用于合并呼吸功能不全患者的腹腔镜手术是安全可行的。

The anesthesia styles and management of laparoscopic operation for patients with respiratory insufficiency

Objective To explore the anesthesia styles and management of laparoscopic operation for patients with respiratory insuffi- eiency. Methods 126 patients with respiratory insufficiency were divided into 4 groups according to the anesthesia way. 42 patients anesthe- tized with target control infusion of remifentanil were considered as group A. 28 patients anesthetized by target control infusion of propofol were regarded as group B. 36 patients in group C anesthetized by isoflurane inhaled and 20 patients in group D anesthetized by venous pumping of propofol combined with remifentanil. The results of arterial blood gas analysis, vital sign, pulmonary ventilation function and recovery after an- esthesia were compared prepneumoperitoneum,5 min and 25 min after pneumoperitoneum,at the end of the operation. Results There were significant differences for HR/MAP after pneumoperitoneum in group B and D （ P 〈 0.05 ）. The level of HR/MAP in group A/C was obvious- ly different compared to group B/D（ P 〈 0. 05 ）. The PCO2/PET CO2 was obviously increased in 4 groups after pneumoperitoneum, but there was no difference between 4 groups. The palinesthesia time of group A was shorter than the other 3 groups（ P 〈 0.05 ）. The palinesthesia time of group C was shorter than the other group B or D （P 〈 0.05 ）. The ratio entered into PACU was lower in group A compared to the other 3 groups. Conclusion The anesthesia of target control infusion of propofol and remifentanil and intravenous and inhalation anesthesia were both safe and feasible for the laparoscopic operation to the patients with respiratory insufficiency.