瑞芬太尼联合异氟烷或异丙酚全麻行腹腔镜胆囊切除术比较

Comparision of haemodynamic,recovery ,nausea and vomiting between remifentanil/propofol and remifentanil/isoflurane for laparoscopic cholecystectomy

目的比较瑞芬太尼联合异氟烷或异丙酚在腹腔镜胆囊切除术(LaparoscopicCholecystectomy,LC)中血流动力学的变化、术后恢复及恶心呕吐的发生。方法择期全麻下行LC病人40例,美国麻醉医师协会(AmericanSocietyofAnesthesiologists,ASA)分级Ⅰ～Ⅱ级,心肺功能正常,随机分成RI组和RP组,各20例,两组全麻诱导用药相同,即咪唑安定、异丙酚、瑞芬太尼和维库溴铵,维持麻醉RI组采用瑞芬太尼联合异氟烷、RP组瑞芬太尼联合异丙酚。记录基础值、诱导后、插管后1min、3min、气腹时、气腹后1、3、5、10、15min的动脉收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)及手术结束至自主呼吸恢复、睁眼、拔除气管导管、恢复定向能力的时间;及术后恶心呕吐的情况。结果两组SBP、DBP、MBP均在诱导后明显低于基础值(P<0.01),气腹开始后趋于平稳;两组HR均在诱导后减慢(P<0.01),插管后及气腹开始即恢复,但都又在气腹3min开始减慢(P<0.05);两组间均无差异。手术结束两组自主呼吸恢复、呼之能睁眼、拔除气管导管及恢复定向能力的平均时间无明显差异。术后发生恶心呕吐的病人数RP组明显减少(P<0.05)。结论气管内插管全麻行LC时,瑞芬太尼联合异氟烷或异丙酚都能缓解气腹及手术引起的血流动力学变化,术后早期复苏,瑞芬太尼联合异丙酚能明显降低术后恶心呕吐的发生率。

Objective To compare haemodynamics,recovery, postoperative nausea and vomiting （PONV）between remifentanil/propofol and remifentanil/isoflurane in patients undergoing laparoscopic choleeystectomy（LC）.Methods Forty patients undergoing selected LC, American Society of Anesthesiologists （ASA） grade Ⅰ-Ⅱ, with normal cardiac and lung function, were randomly divided into 2 groups of 20 patients each：group R1 and group RP. Following induction with midazolam, propofol ,remifentanil and vecuronium ,anaesthesia was maintained with remifentanil/isoflurane in group R1 or remifentanil/propofol in group RP .The systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）and heart rate（HR） were recorded at the time of baseline,after induction, 1min and 3 min after intubation, CO2 insufflation,1min,3min,5min,10 min and 15 min after insufflation. The time interval from operation end to spontaneous respiration,eyes-opening, extubation and orientation were recorded. PONV were observed .Results In the two groups,SBP, DBP and MBP decreased after induction（P〈0.01 ）,and were stable after CO2 insufflation. HR were slow after induction and after CO2 insufflation （P〈0.05）,but there was no significant difference between the two groups at all time in SBP, DBP,MBP and HR. Patients with PONV in group RP was significantly less than that in group R1 （P〈0.05）.Conclusion General anesthesia with remifentanil combined with isoflurane or propofol for laparoscopic cholecystectomy all can alleviate the change of haemodynamics caused by pneumoperitoneum and operation.Patients under the both anesthesias can recover early. Remifentanil combined with propofol can decrease the rate of patient with PONV after LC