静脉快通道麻醉在腹腔镜胆囊切除手术中的应用

Application of intravenous fast-tracking anesthesia in laparoscopic cholecystectomy

目的观察静脉快通道麻醉在腹腔镜胆囊切除手术中的应用,并比较静脉麻醉和吸入麻醉对病人麻醉恢复的影响。方法选择100例ASA体格状况为I、II级,在腹腔镜下行择期单纯胆囊切除手术的病人,随机等分成两组。实验组(静脉全麻组):麻醉诱导采用咪唑安定0.04mg/kg,瑞米芬太尼2μg/kg,异丙酚2mg/kg,阿曲库铵0.6mg/kg诱导后气管插管;麻醉维持采用瑞米芬太尼0.1μg/(kg·min)、异丙酚80～120μg/(kg·min)、阿曲库铵8～10μg/(kg·min)全部采用微泵注射。对照组(吸入麻醉组)麻醉诱导同实验组,麻醉维持采用安氟醚,阿曲库铵8～10μg/(kg·min)微泵注射。两组病人的麻醉深度维持在心率、血压于术前±20%。手术结束后采用Steward评分方法,10min内评分在4分及以上者送回病房,否则送入ICU;记录两组病人术后恶心呕吐的发生情况及其他并发症。结果两组病人手术时间和麻醉时间无明显差异;实验组10min内评分在4分及以上者有43人,对照组为31人,两组相比,P<0.05;实验组术后恶心呕吐12例,对照组27例,P<0.01。结论静脉快通道麻醉可让腹腔镜胆囊切除术病人术后尽早苏醒,降低恶心呕吐发生率,并减少进入PACU或ICU机会。

[Objective] To investigate the effect of intravenous fast-tracking anesthesia on recovery in patients undergoing laparoscopic cholecystectomy and compare it with inhaled anesthesia. [Methods] 100 patients, ASA physical status Ⅰ～Ⅱ, were randomly divided into two groups. All patients were induced with midazolam 0.04 mg/kg, remifentanil 2μg/kg, propofol 2 mg/kg and atracurium 0.6 mg/kg intravenously. Anesthesia was maintained with propofol 80-120μg/（kg·min）, remifentanil 0.1-0.2 μg/（kg· min） and atracurium 8～10μg/（kg·min） intravenously via pump in intravenous anesthesia group （TIVA group） and maintained with enflurane, atracurium 8～10μg/（kg-min） intravenously via pump in inhaled anesthesia group （control group）. Anesthesia depth was maintained to keep NIBP and HR within±20% of preoperative values. The patients were scored using Steward postanesthesia recovery score system after operation completed. Patients with scores of 4 or higher within 10min were transferred to the ward, oth- erwise recovered in ICU until they met the above discharge criteria and were transferred to the ward. Post operative nausea and vomiting （PONV） and other postoperative complications were recorded. [Results] ,13 patients scored 4 or higher within 10 min in TIVA group were transferred to the ward, but 31 in control group, P 〈0.05. Incidence of PONV was 24%（12） in TIVA group, but 54%（27） in control group, P 〈0.01. [Conelusion] Intravenous fast-tracking anesthesia in laparoscopic choleeysteetomy could get a rapid recovery and reduce the incidence of PONV.