瑞芬太尼复合异丙酚静脉麻醉在老年腹腔镜胆囊切除术中的应用

Clinical application of remifentanil and propofol in total intravenous anaesthesia for elderly patients undergoing laparoscopic cholecystectomy

目的观察瑞芬太尼复合异丙酚全凭静脉麻醉应用于老年患者腹腔镜胆囊切除术（LC）的临床疗效及不良反应。方法ASAⅠ-Ⅱ级、择期行LC术的老年患者40例,随机分为瑞芬太尼组（R组）和异氟醚组（I组）,每组20例。两组均以咪唑安定0.04mg·kg^-1、异丙酚1.5mg·kg^-1、芬太尼4μg·kg^-1和维库溴铵0.1mg·kg^-1静脉诱导后气管插管。麻醉维持：Ⅰ组用1.5%-2.5%异氟醚吸入,R组用微量泵输注异丙酚6mg·kg^-1·h^-1和瑞芬太尼0.2-0.5μg·kg^-1·min^-1,分别记录麻醉诱导前、二氧化碳（CO2）气腹后1min、5min、气腹毕和术毕的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）、苏醒时间和镇静评分（OAAS评分）及术后不良反应等。结果CO2气腹后1min、5min,I组的HR、MAP显著高于麻醉诱导前的基础值（P〈0.05）,各时点的血流动力学值也明显高于R组（P〈0.05）,R组术中循环较稳定;R组患者清醒时间为（10.6±3.4）min,I组为（22.8±5.7）min,且R组OAAS评分明显高于Ⅰ组,两组有显著性差异（P〈0.05）;R组的术后躁动、恶心呕吐发生率显著低于Ⅰ组（P〈0.05）。结论瑞芬太尼复合异丙酚全凭静脉麻醉用于老年患者LC术具有麻醉平稳、苏醒质量好、并发症较少的特点,是老年患者行LC术较好的麻醉方法。

Objective To compare the effects and safety of anesthesia with intravenous infusion of remifentanil and propofol in elderly patients undergoing laparoscopic cholecystectomy. Methods Forty elderly patients （ASAⅠ-Ⅱ） undergoing elective laparoscopie cholecystectomy were randomly divided into total intravenous anesthesia group （group R, n = 20） and inhaled anesthesia group（ groupⅠ, n = 20）. The induced anesthesia was performed with midazolam 0.04mg·kg^-1, propefol 1.5 mg·kg^-1 ,fentanyl 4 μg·kg^-1 and vecuronium 0.1 mg·kg^-1 in both groups. The anesthesia was maintained by pumping remifentanil 0.2 -0.5 μg·kg^-1·min^-1 , propofol 6 mg·kg^-1·h^-1 with mieropump in group R, while patients in the group Ⅰ, maintained with inhalation of 1.5% -2.5% isoflurane. Hemedynsmie changes were monitored during anesthesia. Some indices , such as SBP, DBP, MAP, HR and SPO2 , were recorded at 5 intervals including before anesthesia, 1, 5min after pneumoperitoneum ,at the end of pneumoperitoneum and at the end of operation. Recovery time,OAAS score after extubation, postoperative nausea and vomiting （ PONV ） and other postoperative complications were observed. Results MAP and HR increased significantly after pneumoperitoneum （ P 〈 0.05） in group Ⅰ , whereas there was no significant change in MAP and HR in group R. Data of hemedynaraies in group Ⅰ were significantly higher than those in group Ⅰ during operation（ P 〈 0.05）. Recovery time in group Ⅰ was significantly longer than that in group R（ P 〈 0.05）. The patients in group R had higher OAAS scores after extubation than those in group Ⅰ （ P 〈 0.05）. The incidence of PONV in group R was lower than that in group I（ P 〈0.05）. Conclusion The intravenous anesthesia using remifentanil and propefol is effective in keeping the stability of hemedynamios, making awake quickly. It is a good method for elderly patients undergoing laparoscopic cholecystectomy.