瑞芬太尼复合丙泊酚全凭静脉麻醉在腹腔镜胆囊切除术中的应用

目的观察瑞芬太尼复合丙泊酚在腹腔镜胆囊切除术（LC）的麻醉效果及安全性。方法将我院80例择期行Lc的患者完全随机分为对照组及观察组，各40例。对照组采用静吸复合麻醉；观察组采用全凭静脉麻醉。观察2组手术麻醉前后平均动脉压、HR的变化并加以比较，比较2组术后苏醒时间和拔管时间以及警觉－镇静评分（OAAS评分）。结果观察组与对照组患者切皮后和术毕的平均动脉压和HR与诱导前比较差异均有统计学意义（P〈0．05）；对照组患者切皮后、术毕的平均动脉压、HR高于观察组患者平均动脉压：（83±10）mmHg（1mmHg=0．133kPa）比（76±8）mmHg，（89±10）mmHg比（80±8）mm Hg；HR：（78±12）次／min比（704-8）次／min，（854-8）次／minE（76±6）次／min]，差异有统计学意义（均P〈0．05）。观察组患者术后苏醒时间和拔管时间少于对照组分别为（6±2）nlin比（11±2）min，（11±2）min比（16±2）min，均P〈0．05]，且OAAS评分明显高于对照组（4．3±1．6）分比（3．0±1．3）分，尸〈0．05]。结论与静吸复合麻醉比较，瑞芬太尼复合丙泊酚全凭静脉麻醉维持平稳，术中血流动力学稳定，术后苏醒快，拔管早，安全可行。

Application of total intravenous anesthesia with remifentanil and propofol for laparoscopic cholecystectomy

Objective To explore anesthetic efficacy and reliability of remifentanil and propofol for laparoscopic cholecystectomy. Methods Eighty patients scheduled for laparoscopic cholecystectomy were randomly divided into control group and observation group（40 cases in each group）. Patients in the control group were treated with inhalation anesthesia, while those in the observation group received total intravenous anesthesia. Mean arterial pressure （MAP） and heart rate（HR） were observed and compared before and after observation in two groups, and recovery time, extubation time and alert-calm score （OAAS） post Operation were compared in two grouPs. Results Compared to before observation, there was a significant difference in MAP and HR in two groups （ all P 〈 0.05 ）. The MAP （ 83± 10） mm Hg （ 1 mm Hg = 0.133 kPa） vs （76 ± 8 ） mm Hg, （ 89 ± 10） mm Hg vs （ 80 ± 8） mm Hg ] and HR （78± 12）times per min vs （70 ±8）times per min, （85 ±8 ）times per min vs （76±6 ）times per rain ] after incision and postoperation in the control group were higher than those in the observation group（ all P 〈 0.05 ）. The postoperative recovery time and extubation time in observation group were less than those in control group （6 -＋ 2）min vs （11 _＋2） min, （11 _＋2）rain vs （16 ±2） rain, respectively, all P 〈0.05], and the OAAS score was higher than that in control group （P 〈 0.05 ）. Conclusions Compared with the control group, patients in the observation group remain stable anesthesia and hemodynamic stability. They wake up earlier after surgery and have earlier extubation than those in the control group. Therefore, it is safe and feasible to apply remifentanil and.propofol during laparoscopic cholecystectomy.