腹腔镜胆囊切除术中异丙酚复合瑞芬太尼行靶控静脉麻醉效果观察

目的比较异丙酚复合瑞芬太尼或芬太尼在腹腔镜胆囊手术行靶控输注(TC I)全凭静脉麻醉时对血流动力学及恢复情况的影响。方法ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除术患者100例,随机分为瑞芬太尼组和芬太尼组各50例;复合异丙酚行靶控血浆浓度输注并观察记录麻醉诱导、气管插管时心率、血压的变化、术毕停麻醉药后患者自主呼吸恢复、送术后恢复室(PACU)、呼之睁眼、拔管、定向力恢复和离开PACU时间;并根据OAA/S及VRS评分,记录患者意识状态、疼痛评分及副反应情况。结果2组患者在麻醉诱导时、气管插管即刻、气管插管后3 m in、气腹时及术后5 m in、拔管时血压和心率的变化、术毕停药后呼吸恢复时间、送PACU时间、呼之睁眼时间、拔管后时间;拔管后即刻、回病房后1.5 h的OAA/S及VRS评分均有显著差异(P<0.05);术后瑞芬太尼组躁动和高血压发生率明显高于芬太尼组(P<0.05)。结论瑞芬太尼TC I麻醉诱导、气管插管时及术中心血管反应小,术后恢复快,正确处理并发症不失为理想的麻醉镇痛药。

Effects of intravenous anesthesia with target controlled infusion of propofol combined with remifentanil in patients performed with laparoscopic cholecystectomy

Objective To compare the influence of remifentanil and fentanyl on the haemodynamics at the time of anesthesia induction and intubation and the recovery process after operation.Methods One hundred ASA Ⅰ-Ⅱ patients undergoing elective laparoscopic cholecystectomy were randomly divided into two groups of 50 patients each,remifentanil group and fentanyl group.Anesthesia was maintained with propofol and remifentanil or fentanyl by intravenous continuous infusion.The changes of haemodynamics were recorded at he time of anesthesia induction and intubation.The recovering time of spontaneous breathing and the time when patients were in post-anesthctic ICU(PACU) were also recorded.The cognitive funtion,pain score and side effects after operation were recorded by OAA/S and VRS score.Results There were significant differences in the haemodynamics changes of anesthesia induction and instant intubation,3 min after intubation,during the operation,5 min after operation and at extubation during operation and after operation.The recovering time of spontaneous breathing and cognition and the time of patients in PACU were significantly different between two groups.The OAA/S and VRS scores of two groups were significantly different in the time of extubation,leaving PACU,and 1 h,5 h,after operation.The postoperative pain was also significantly different(P<0.05).There were significant differences between two groups in restlessness and incidence of hypertension after operation.(P<0.05).Conclusion Remifentanil is an ideal narcotic analgesic by intravenous continuous infusion for less haemodynamic changes at the time of anesthesia induction and intubation and short recovering time after operation.