丙泊酚与瑞芬太尼靶控输注对腹腔镜胆囊切除术的麻醉效果及病人术后认识功能的作用

目的:探讨胆囊切除术病人以丙泊酚与瑞芬太尼靶控输注镇痛的麻醉效果及其对病人术后认识功能的作用和影响。方法:将64例接受腹腔镜胆囊切除术病人作为研究对象，对照组（32例）予以静脉注射丙泊酚、芬太尼，观察组（32例）予以靶控输注丙泊酚、瑞芬太尼。结果:插管前和插管后，2组病人收缩压、舒张压以及心率差异均无统计学意义（P>0.05），2组插管后舒张压和心率高于插管前水平（P<0.05~P<0.01）。2组病人术后自主呼吸恢复时间、睁眼时间、麻醉时间以及拔管时间差异无统计学意义（P>0.05），观察组定向力完全恢复时间显著短于对照组（P<0.01）。与拔管时比较，拔管24 h后对照组OAAS评分明显升高（P<0.01），NRS评分明显降低（P<0.01），观察组OAAS、MMSE评分均明显增高（P<0.01），NRS评分明显降低（P<0.01）；且拔管24 h观察组的MMSE评分明显高于对照组（P<0.05），NRS评分明显低于对照组（P<0.05）。2组各方面术后并发症发生率差异均无统计学意义（P>0.05）。结论:针对胆囊切除术病人以丙泊酚与瑞芬太尼靶控输注，其血流动力学更加平稳、病人苏醒质量更佳，效果明显，值得推广应用。

Effect of the targeted infusion of propofol and remifentanil on the anesthesia effect and postoperative cognitive function in patients treated with laparoscopic cholecystectomy

Objective: To explore the effects of the targeted infusion of propofol and remifentanil on the anesthesia effect and postoperative cognitive function in patients treated with laparoscopic cholecystectomy.Methods: The patients treated with laparoscopic cholecystectomy was divided into the control group and observation group.The control group was intravenously injected with propofol and fentanyl,and the observation group was treated with target infusion of propofol and remifentanil.Results: The differences of the systolic pressure,diastolic pressure and heart rate between two groups before and after intubation were not statistically significant(P>0.05),and the diastolic pressure and heart rate in two groups after intubation were higher than those before intubation(P<0.05 to P<0.01).The differences of the postoperative recovery time of spontaneous breathing,eye opening time,anesthesia time and extubation time between two groups were not statistically significant(P>0.05),and the recovery time of orientation in observation group was significantly shorter than that in control group(P<0.01).Compared with the extubation,after 24 h extubation,the OAAS score of the control group increased significantly and the NRS score decreased significantly(P<0.01),The score of OAAS and MMSE in the observation group increased significantly(P<0.01) and the NRS score decreased significantly(P<0.05),and the MMSE score of the 24 h observation group was significantly higher than that of the control group(P<0.05).The difference of the incidence rate of postoperative complications between two groups was not statistically significant(P>0.05).Conclusions: The targeted infusion of propofol and remifentanil in patients treated with laparoscopic cholecystectomy can sustain hemodynamics and improve the quality of sleep,which has good effect and is worthy of application and promotion.