全凭静脉麻醉对腹部手术患者血液动力学及苏醒时间的影响

Effect of total intravenous anesthesia on hemodynamics and wake-up time in patients with abdominal surgery

目的评价丙泊酚-瑞芬太尼全凭静脉麻醉对腹部手术患者血液动力学及全麻苏醒时间的影响。方法ASAⅠ￣Ⅱ级择期腹部手术患者80例,随机分为两组(每组各40例):A组与B组。静脉诱导后气管插管,A组采用吸入1%～2%异氟醚维持麻醉,根据需要追加瑞芬太尼1!g/kg,B组采用靶控输注丙泊酚与瑞芬太尼维持麻醉,丙泊酚与瑞芬太尼靶浓度分别为2～4mg/L、2～5"g/L。两组均采用间断静脉注射维库溴铵维持肌松。记录围术期血液动力学的变化及苏醒时间。结果与麻醉前比较,在切皮后5min、睁眼时、拔管时A组血压与心率均升高(P<0.05),而B组改变无统计学意义(P>0.05)。手术结束后B组患者苏醒时间短于A组(P<0.05)。结论腹部手术患者采用全凭静脉麻醉血液动力学稳定,患者苏醒快,优于静吸复合麻醉。

Objective To investigate hemedynamic change and wake-up time in patients with abdominal surgery under total intravenous anesthesia. Methods Eighty ASA Ⅰ-Ⅱ patients aged 25-60 years scheduled for abdominal surgery under general anesthesia were randomly allocated into two groups （n=40 eaeh）：group A and group B. The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Anesthesia was induced with midazolam 0.02 mg· kg^-1, fentanyl 3μg·kg^-1 and propofol 2 mg·kg^-1. Tracheal intubation was facilitated with succinylcholine 1.6 mg·kg^-1. In group A, anesthesia was maintained with inhalational 1%-2% isofluranc and intermittent iv bolus of fentanyl, while in group B anesthesia was maintained with target controlled infusion of propofol and remifentanil. The target concentrations of propofol and remifentanil were set with 2-4 mg/L, 2-5 μg/L respectively. Vecuronium bromide was given intermittent to maintain muscle relaxation in both groups. Blood pressure （Bp） and heart rate （HR） were continuously monitored. The wake-up time was recorded at the end of operation. Results The two groups were comparable with respect to demographic data. In group A, Bp and HR were increased significantly at the time of skin incision, when patients open eyes and extubation. But in group B hemodynamics were stable during operation. The wake-up time was shorter in group B than in group A（P 〈 0.05）. Conclusion Total intravenous anesthesia with propofol and remifcntanil is superior to isotlurane inhalation in terms of hemodynamics and wake-up time.