雷米芬太尼联合丙泊酚用于腹腔镜胆囊切除术麻醉的疗效分析

目的:观察分析雷米芬太尼联合丙泊酚用于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)麻醉的临床疗效。方法:选取2005年1月至2012年5月收治的50例拟行LC的患者,随机平均分为两组,对照组使用芬太尼复合丙泊酚进行麻醉,治疗组使用雷米芬太尼联合丙泊酚。分别监测记录两组患者基础值(T1)、行气管插管(T2)、建立人工气腹(T3)及切皮后1 min(T4)的心率(heart rate,HR)及平均动脉压(mean arterial pressure,MAP);观察记录两组患者呼吸、意识恢复时间,拔管时间,切口疼痛程度,患者术中知晓率及24 h内恶心呕吐状况。结果:治疗组各时点的MAP及HR明显低于对照组(P<0.05)。治疗组术后呼吸恢复时间、意识恢复时间、拔管时间明显短于对照组(P<0.05),术后疼痛者明显少于对照组(P<0.05),两组患者术中均未出现知晓情况,术后24 h内恶心呕吐发生率差异无统计学意义(P>0.05)。结论:雷米芬太尼联合丙泊酚用于LC手术麻醉具有停药后苏醒更快、延迟性呼吸抑制发生率更低等优点,适于非住院患者手术麻醉,利于门诊手术患者的早期康复。

Analysis of curative effect of remifentanyl combined with propofol in anesthesia of laparoscopic cholecystectomy

Objective: To observe and analyze the clinical curative effect of using remifentanyl combined with propofol for anesthesia in the laparoscopic cholecystectomy(LC).Methods: Fifty patients who intended to undergo LC from Jan.2005 to May 2012 were selected and randomly divided into control group and treatment group(n = 25).Fentanyl compounded with propofol was used for anesthesia in control group,while remifentanyl combined with propofol was used for anesthesia in treatment group.Heart rate(HR) and mean arterial pressure(MAP) were monitored and recorded in the two groups at base values(T 1),endotracheal intubation(T 2),making artificial pneumoperitoneum(T 3) and 1 min after cutting skin(T 4) respectively.The following data were observed and recorded in the two groups: recovery time of breath and consciousness,time of extubation,incision pain,intraoperative awareness rate,nausea and vomiting within 24 h.Results: Treatment group's MAP and HR at each time point were obviously lower than control group's(P < 0.05),and treatment group's time of respiratory recovery,awareness recovery and extubation were obviously shorter than control group's after operation(P < 0.05),and the number of patients who complained pain after operation in treatment group was evidently fewer than control group(P < 0.05),there was no awareness appeared during the operation in the two groups,and there were no statistically significant differences between the two groups in rate of nausea and vomiting within 24 h after operation(P > 0.05).Conclusions: Remifentanyl combined with propofol for anesthesia in the LC can make patients regain consciousness faster,reduce rate of delayed respiratory depression after discontinuation.The remifentanyl combined with propofol are suitable for the surgical anesthesia of out-patients,and it makes contribution to their early rehabilitation.