腹腔镜胆囊切除术患者异丙酚复合瑞芬太尼与七氟醚麻醉效果的比较

目的 比较腹腔镜胆囊切除术患者异丙酚复合瑞芬太尼与七氟醚麻醉的效果.方法 择期行腹腔镜胆囊切除术患者120例,ASA Ⅰ或Ⅱ级,年龄18～64岁,体重45～80kg,性别不限,随机分为异丙酚复合瑞芬太尼组(PR组)和七氟醚组(S组),每组60例.麻醉诱导:PR组异丙酚效应室靶浓度3μl/ml,瑞芬太尼效应室靶浓度6 ng/ml;S组高流量吸入8%七氟醚-氧化亚氮.麻醉维持:PR组异丙酚效应室靶浓度2～3μg/ml,瑞芬太尼效应室靶浓度2～6 ng/ml;S组维持七氟醚呼气末浓度1.3%～2.2%.记录诱导时间、麻醉时间、睁眼时间、拔管时间、手术时间和PACU停留时间;于拔管后即刻、拔管后30、60 min和离开PACU时采用警觉/镇静评分(OAA/S)评价意识状态;于术前和术后1 h采用MMSE简易智能量表评价认知功能;PACU期间采用VAS评分评价疼痛程度,并记录芬太尼的用量和使用情况;记录术中血管活性药物的使用情况;记录术中和PACU期间不良反应发生情况;于术后24 h进行随访,记录术中知晓的发生情况及患者对麻醉的满意情况.结果 与PR组比较,S组诱导时间缩短,睁眼时间和PACU停留时间延长,拔管后即刻和拔管后30 min时OAA/S评分降低,PACU期间芬太尼使用率和芬太尼用量降低,恶心呕吐发生率升高,术中降压药使用率升高(P＜0.05或0.01);两组术前及术后1 h时MMSE评分均在24分以上;两组诱导过程中胸壁强直、咳嗽和喉痉挛和窒息感的发生率、患者对麻醉满意率差异无统计学意义(P＞0.05).结论 腹腔镜胆囊切除术患者异丙酚复合瑞芬太尼麻醉或七氟醚麻醉的效果较好,两种麻醉方法之间无绝对的优势.

A comparison of propofol-remifentanil versus sevoflurane for laparoscopic cholecystectomy

Objective To compare the efficacy of anesthesia with TGI of propofol-remifentanil and sevoflurane for laparoscopic cholecystectomy.Methods One-hundred and twenty ASA Ⅰ or Ⅲ patients of both sexes aged 18-64 yr weighing 45-80 kg undergoing elective laparoscopic cholecystectomy were randomly divided into 2 groups(n=60 each):group Ⅰ propofol-remifentanil(PR)and group Ⅱ sevoflurane(S).In group PR anesthesia was induced and maintained with TCI of propofol-remifentanil.The target effect-site concentration of propofol and remifentanil were set at 3μg/ml and 6 ng/ml during induction and at 2-3 μg/ml and 2-6 ng/ml during maintenance of anesthesia respectively.In group S anesthesia was induced with 8%sevoflurane-50%N2O-O2(FGF=10 L/min)and fentanyl 2 μg/kg and maintained with 1.3%-2.2%sevoflurane-50%N2O-O2(FGF=2 L/min).All patients were intubated and mechanically ventilated.Tracheal intubation was facilitated with vecuronium 0.1 mg/kg.The following variables were recorded:duration of induction;eye-opening time;extubation time;duration of anesthesia and operation;length of stay in PACU;OAA/S scores(5=fully awake,1=asleep)immediately and at 30,60 min after extubation and while leaving PACU;MMSE before anesthesia and 1 h after operation;the number of the patients who needed fentanyl for analgesia and the amount of fentanyl given;the vasoactive drugs used during operation;complications during operation and stay in PACU and awareness.Results The duration of induction was significantly shorter,eye-opening time and the length of stay in PACU were longer,and the OAA/S scores immediately and at 30 min after extubation were lower in group S than in group PR.Less patients needed fentanyl for analgesia in PACU and the amount of fentanyl was less,the antihypertensive used during operation and the incidence of postoperative nausea and vomiting were higher in group S than in group PR.The majority of the patients in both groups(98%)were happy with the anesthesia they received and would choose the same anesthetics again if needed.Conclusion Each technique has its advantage and disadvantage for laparoscopic cholecystectomy.