瑞芬太尼复合丙泊酚麻醉对腹腔镜胆囊切除术中血流动力学的影响

目的探讨瑞芬太尼复合丙泊酚全凭静脉麻醉对腹腔镜胆囊切除术(LC)中血流动力学的影响。方法将2011年8月至2013年8月阳江市人民医院收治的220例LC患者采用随机数字表法分为对照组和研究组各110例,对照组采用静吸复合麻醉,研究组采用瑞芬太尼、丙泊酚全凭静脉麻醉,比较两组患者不同时点间血流动力学指标及意识状态评分情况。结果研究组患者在气腹后10 min、气腹结束及手术完毕的心率和收缩压低于对照组(P<0.05),研究组各时点间舒张压均高于对照组(P<0.05)。研究组的睁眼时间、拔管时间、自主呼吸恢复时间、定向力恢复时间、离开恢复室时间均显著少于对照组(P<0.05)。研究组在拔管后即刻、1 h、4 h、离开恢复室时间的意识状态评分均显著高于对照组(P<0.05)。结论瑞芬太尼复合丙泊酚全凭静脉麻醉在LC中效果满意、术后患者清醒快、可保证麻醉深度,减轻患者的痛苦且避免手术室的空气污染,值得临床推广使用。

Influence on Hemodynamics in Laparoscopic Cholecystectomy by Remifentanil and Propofol Anesthesia

Objective To discuss the effect of remifentanyl combined with propofol total intravenous anesthesia on hemodynamics during laparoscopic cholecystectomy（LC）.Methods A total of 220 cases of LC from Yangjiang City People＇s Hospital during Aug.2011 and Aug.2013 were included,and were randomly divided into control group and study group,each of 110 cases.The control group adopted inhalation combined with venous anesthesia;the study group adopted remifentanil and propofol total intravenous anesthesia.The hemodynamic status score and awareness situation of the two groups at different time points were compared.Results The heart rate and systolic blood pressure of patients in the study group at 10 min after pneumoperitoneum,pneumoperitoneum end and surgery completionwere all lower than the control group （P 〈 0.05）,diastolic blood pressure of the study groups at each time point were higher（P 〈 0.05）.Eye opening time,extubation time,spontaneous breathing recovery time,orientation recovery time,leaving the recovery room time of the study group were significantly less than the control group（P 〈 0.05）.State of consciousness scores of the study group at the time points of immediate after extubation,1 h,4 h,leaving the recovery room were significantly higher（P 〈 0.05）.Conclusion Remifentanil and propofol total intravenous anesthesia in LC has satisfactory effect,with fast consciousness recovery,ensurance of the depth of anesthesia to alleviate the suffering of patients and avoidance from operating room air pollution,thus is worthy of promotion in clinical.