丙泊酚复合瑞芬太尼靶控输注在腹腔镜胆囊切除术中的应用

目的:观察丙泊酚复合瑞芬太尼靶控输注全凭静脉麻醉对腹腔镜胆囊切除术血流动力学及术后苏醒时间的影响。方法:50例择期行腹腔镜胆囊切除术的患者均采用丙泊酚复合瑞芬太尼靶控输注全凭静脉麻醉。设定诱导时静注咪达唑仑2mg,先血浆靶控输注瑞芬太尼4ng/ml,1min后血浆靶控输注丙泊酚3μg/ml或3.5μg/ml,患者意识消失后静注维库溴铵0.1mg/kg,3min后气管内插管,插管后丙泊酚靶浓度调至2μg/ml,术中维持根据需要调整丙泊酚靶浓度,以0.2μg/ml递增或递减,瑞芬太尼维持不变。记录诱导前、诱导后2min、插管即刻、插管后5min、气腹时、气腹后5min的收缩压(systolic bloodpressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)及术后呼吸恢复时间、呼之睁眼时间。结果:诱导后2min的SBP、DBP、HR与诱导前差异均有统计学意义(P0.05),气腹时SBP、DBP、HR有所升高,但差异无统计学意义,其他时点经适当调整丙泊酚靶浓度处理后逐渐平稳,术后呼吸恢复时间为(6.5±2.2)min,呼之睁眼时间(8.9±3.1)min。结论:丙泊酚复合瑞芬太尼靶控输注用于腹腔镜胆囊切除术安全,术中血流动力学平稳,术后苏醒快。

Application of propofol combined with remifentanil target-controlled infusion in laparoscopic cholecystectomy

Objective:To observe the influence of total intravenous anesthesia with propofol and remifentanil target-controlled infusion on the hemodynamics and postoperative analepsia time in laparoscopic cholecystectomy(LC).Methods:Fifty patients who would receive LC underwent total intravenous anesthesia with propofol and remifentanil target-controlled infusion.At induction,2mg midazolam was injected,4ng/ml remifentanil was target-controlled infused at first,1min later,3μg/ml or 3.5μg/ml propofol was target-controlled infused,after consciousness disappeared,0.1mg/kg vecuronium was injected iv.,3min later endotracheal intubation was applied,after which propofol target level was adjusted to 2μg/ml.The propofol target level for intraoperative maintenance was adjusted according to requirement,increased or decreased by 0.2μg/ml,remifentanil was sustained.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),postoperative respiration recovery time and eyes opening time when called were recorded before induction,2min after induction,intubation,5min after intubation,pneumoperitoneum and 5min after pneumoperitoneum.Results:SBP,DBP and HR at 2min after induction was significantly different compared with those before induction(P<0.05).SBP,DBP and HR increased at pneumoperitoneum,but the difference was not significant,at other time points,the indexes were stable after propofol target level was appropriately adjusted.The postoperative respiration recovery time was(6.5±2.2)min,eyes opening time when called was(8.9±3.1)min.Conclusions:The propofol and remifentanil target-controlled infusion is safe in LC,the intraoperative hemodynamics is stable,and postoperative analepsia time is short.