丙泊酚靶控输注麻醉与七氟醚吸入麻醉用于腹腔镜手术的比较

Comparison of target controlled propofol infusion and sevoflurane inhalational anesthesia in laparoscopic cholecystectomy

目的比较丙泊酚靶控输注(TCI)麻醉与七氟醚吸入麻醉用于腹腔镜胆囊切除术对患者血流动力学及术后恢复的影响。方法60例择期行腹腔镜胆囊切除术患者,ASAⅠ～Ⅱ级,随机分为丙泊酚TCI组(P组,n=30)和七氟醚吸入组(S组,n=30)。术中麻醉,P组输注血浆靶浓度为3μg/ml丙泊酚,S组持续吸入2%七氟醚(氧流量2L/min),两组按需追加芬太尼和维库溴铵。分别记录两组病人麻醉前(T1)、气管插管后即刻(T2)、手术开始即刻(T3)、气腹后10min(T4)及手术结束即刻(T5)的平均动脉压(MAP)和心率(HR),记录停药后完全清醒时间、术后24h恶心呕吐(PONV)发生率。结果与S组比较,P组T4时点的MAP较低,HR较慢(P<0.05),其他时点的MAP、HR比较差异无统计学意义(P>0.05)。停药后完全清醒时间两组间比较差异无统计学意义(P>0.05),但术后24hPONV发生率P组明显低于S组(P<0.05)。结论丙泊酚TCI麻醉和七氟醚吸入麻醉用于腹腔镜胆囊切除术均可产生良好的麻醉效应,维持术中血流动力学稳定,术后苏醒迅速完全,但丙泊酚TCI麻醉比七氟醚吸入麻醉术后恶心呕吐发生率低。

Objective To compare the effects of propofol target controlled infusion （TCI） and sevoflurane inhalational anesthesia on the hemodynamics and postoperative recovery in patients undergoing laparoscopic cholecystectomy. Methods Sixty ASA Ⅰ or Ⅱ patients scheduled for laparoscopic cholecystectomy were randomized into propofol TCI group （group P） and sevoflurane inhalational anesthesia group （group S）. In group P, TCI propofol was maintained after intubation until incision closure with the target concentration at 3 μg/ml. In group S, sevofturane （end-tidal concentration of 2%） was maintained with oxygen flow rate of 2 L/min until incision closure. Fentanyl and vecuronium were intravenously infused according to the depth of anesthesia during the operation. MAP and HR were measured before anesthesia （T1）, immediately after intubation （T2）, at skin incision （T3）, 10 min after pneumoperitoneum （T4） and immediately after completion of the operation （T5） respectively. Awake time, postoperative nausea and vomiting of the patients were observed after operation. Results There was significant difference in MAP and HR at T4 between the two groups （P〈0.05）, but not at T1, T2, T3 and T5 （P〉0.05）. No significant difference was also found in the awake time between the two groups （P〉0.05）. The incidence of PONV, however, was significantly lower in group P than in group S （P〈0.05）. Conclusion Propofol TCI and sevofturane inhalational anesthesia are all effective in inducing good anesthetic effect, maintaining hemodynamic stability and ensuring rapid recovery, but propofol TCI causes lower incidence of PONV in operations such as laparoscopic cholecystectomy.