靶控输注异丙酚在妇科腹腔镜手术中的应用

目的观察靶控输注（TCI）异丙酚在妇科腹腔镜手术中应用的可行性。方法选择ASAI～Ⅱ级妇科择期腹腔镜手术患者60例，随机分为2组（n=30）。TCI组采用异丙酚TCI3mg／L，对照组静脉输注异丙酚1．5mg／kg，咪达唑仑0．04mg／kg、芬太尼0．003mg／kg、万可松0．1mg／kg诱导。术中吸入2％异氟醚，TCI组给予异丙酚1mg／L，对照组异丙酚3mg·kg·h-1，间断给予芬太尼和万可松维持麻醉。记录麻醉前（T0）、气管插管时（T1）、插管后即刻（T2）、插管后5min（T3）、手术结束前10min（T4）2组的平均动脉压（MAP）、心率（HR）和停止输注异丙酚至患者苏醒时间、手术时间和异丙酚的用量。结果T2时2组MAP均明显升高（P〈0．05），T2时TCI组MAP较对照组低（P〈0．05）；与T1时比较，T2时2组HR增快（P〈0．05）；TCI组异丙酚用量比对照组减少，苏醒时间比对照组缩短（P〈0．05或P〈0．01）。结论异丙酚TCI麻醉用于妇科腹腔镜手术能够较好地减轻插管反应、减少异丙酚用量、缩短苏醒时间，值得临床推广。

The propofol which is injected by the target controlled infusion system used in laparoscope operation of gynecology

Objective To investigate the feasibility of the propofol which is injected by the target controlled infusion （TCI） system used in laparoscope operation of gynecology. Methods Sixty patients （ASA I - Ⅱ） undergoing laparo- scope operation of gynecology were randomly assigned to two groups （ n = 30 ）. All patients received general anesthesia, they were induced by midazolam 0.04 mg·kg-1, fentanyl 0. 003 mg·kg-1, veeuronium 0.1 mg· kg-1. Anesthesia was maintained with 2% isoflurane inhalation, continuous infusion propofol of 1 mg/L （group I ） or 3 mg· kg-1· h-1 （group Ⅱ ） and inject fentanyl and vecuronium. The mean arterial blood pressure （MAP） and heart rate （HR） before anesthesia （ TO ）, during intubation （ T1 ）, immediately after intubation （ T2 ）, 5 minutes （ T3 ） after, 10 minutes before the end of the operation （ T4 ）. And record the operation time, the total quantity of propofol and the time from stopg injec- ting the propofol to the patient awake. Results MAP was higher at T2 than T1 （ P 〈 0.05 ） and it was lower in group I than that in group Ⅱ at T2 （ P 〈 0.05 ）. HR was faster in two groups at T2 than T1 （ P 〈 0.05 ）. The operation time had no statistical difference in two groups （ P 〉 0.05 ）. The total quantity of propofol used in group I was fewer than that in group Ⅱ （ P 〈 0.05 ）. The awekening time was longer in group Ⅱthan that in group I （ P 〈 0.01 ）. Conclusion The propofol which is injected by TCI system used in laparoscope operation of gynecology, it can alleviate the patients reaction at intubation and a shorter awakening time.