瑞芬太尼普鲁泊福靶控输注静脉麻醉用于腹腔镜胆囊切除术

目的 :评价普鲁泊福和瑞芬太尼靶控全静脉麻醉临床应用的可行性。方法 :ASAI Ⅱ级 ,择期行腹腔镜胆囊切除手术的病人 16例 ,诱导时设定普鲁泊福血浆靶浓度 3mg·L-1,瑞芬太尼血浆靶浓度 7μg·L-1,术中靶浓度维持不变 ,手术结束时停止输注普鲁泊福和瑞芬太尼。观察麻醉诱导和气管插管时的血压、心率 ,术毕停药后病人自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间和离开恢复室时间。分别在靶控输注 15min、2 0min、术毕病人苏醒时采集桡动脉血样用高效液相色谱仪配二极管阵列紫外检测器测定瑞芬太尼全血浓度。结果 :麻醉诱导时收缩压由诱导前 (14 4± 2 7)mmHg降至 (10 1± 18)mmHg ,平均动脉压由 (10 2± 15 )mmHg降至 (6 9±13)mmHg ,心率由 (77± 14 )次·min-1降至 (6 3± 12 )次·min-1,插管前后血压和心率无显著变化 ,无一例插管反应。术毕停药后病人自主呼吸恢复时间 (12± 6 )min ,呼之睁眼时间 (9± 4 )min ,拔管时间 (13± 6 )min ,定向力恢复时间 (15± 5 )min ,离开恢复室时间 (19± 7)min。瑞芬太尼的实测浓度分别为 (4 .6± 9.5 ) μg·L-1、(6 .6± 11.5 )μg·L-1、(1.2± 8.7) μg·L-1。结论 :瑞芬太尼普鲁泊福靶控全静脉麻醉用于腹腔镜胆囊切除手术时 ,麻醉诱导平稳 ,术

Target-controlled infusions of remifentanil and propofol during laparoscopic cholecystectomy

OBJECTIVE: To evaluate the clinical profile of target-controlled infusion-based anesthesia using remifentanil and propofol. METHODS: 16 ASA I-II patients undergoing elective laparoscopic cholecystectomy were enrolled. Remifentanil was set at 7 micrograms.L-1 as target and profol at 3 mg.L-1 throughout the whole procedure. The hemodynamics during induction of anesthesia and recovery profiles were recorded. Arterial blood samples for analysis of remifentanil were taken 15 min after infusion, 20 min after infusion and at time of emergence. RESULTS: After induction of anesthesia, systolic blood pressure (SBP) decreased from (144 +/- 27) mm Hg to (101 +/- 18) mm Hg (P < 0.05), mean blood pressure (MBP) decreased from (102 +/- 15) mm Hg to (69 +/- 13) mm Hg (P < 0.05) and heart rate (HR) decreased from (77 +/- 14) beats.min-1 to (63 +/- 12) beats.min-1 (P > 0.05). SBP, MBP and HR remained stable after intubation for 3 min. No patient showed haemodynamic stress to tracheal intubation. Times from stopping administration of anesthetics until full spontaneous respiration, eye opening, tracheal extubation, orientation and discharging from the postanesthetic care unit (PACU) were (12 +/- 6), (9 +/- 4), (13 +/- 6), (15 +/- 5) and (19 +/- 7) min respectively. Measured drug values of remifentanil were (4.6 +/- 9.5) microgram.L-1, (6.6 +/- 11.5) microgram.L-1, (1.2 +/- 8.7) microgram.L-1 respectively. CONCLUSION: Remifentanil/propofol TCI-based anesthesia achieved the optimal hemodynamic stability during anesthesia induction and maintenance, and better recovery profile from anesthesia. Measured drug values of remifentanil showed a considerable interindividual variation and more lower than the set target.