瑞芬太尼复合芬太尼全凭静脉麻醉用于腹腔镜胆囊切除术的临床研究

A Comparative Study on Propofol Intravenous Balanced Anesthesia with Infusion of Remifentanil Combined with Fentanyl During Laparoscopic Cholecystectomy

目的对比研究瑞芬太尼复合芬太尼全凭静脉麻醉与单纯使用瑞芬太尼或芬太尼静脉复合麻醉用于腹腔镜胆囊切除术(LC)的效果。方法60例择期LC患者,随机分为三组:单纯瑞芬太尼组(R)、瑞芬太尼+芬太尼组(RF)和单纯芬太尼组(F)(n=20)。观察记录全麻诱导、维持及苏醒期平均动脉压(MAP)、心率(HR)、SpO2,停药至患者自主呼吸恢复时间、意识恢复时间、拔除气管导管时间,病人拔管后即刻、1、3、7、12 h的疼痛程度评分(VRS)、意识状态评分(OAAS)及苏醒期并发症。结果与RF、F组及组内诱导前比,R组诱导插管时MAP较低,HR较快,术毕MAP较高,HR增快,术中维持过程无明显差异。RF、F两组间及组内在诱导与维持过程MAP及HR无明显差异,拔管及离开手术室时RF组MAP升高、HR增快。R、RF两组术后各观察指标时间差异无显著性,F组明显延长。三组术后并发症无统计学差异。R组术后VRS明显高于RF、F组(P<0.01);组内与拔管后即刻相比,R组术后VRS评分均明显升高,RF、F组无明显变化。F组在拔管后即刻,术后1、3 h的OAAS均明显低于R、RF组(P<0.01)。结论与单纯使用瑞芬太尼或芬太尼麻醉相比较,在麻醉诱导期复合使用瑞芬太尼和芬太尼,后期再以瑞芬太尼维持麻醉,其麻醉效应更加平稳,苏醒质量不受明显影响,术后不良反应更轻,并可减少患者术后对于镇痛的要求。

Objective To compare the effects of propofol intravenous balanced anesthesia with infusion of remifentanil combined with fentanyl to simple infusion of remifentanil or fentanyl during laparoscopic cholecystectomy （LC）. Methods Sixty patients scheduled for LC were randomly divided into three groups with fentanyl group （RF） and simple fentanyl group （F）. Mean （ n = 20 ） ： simple remifentanil group （ R ）, remifentanil combined arterial pressure （MAP）, heart rate （HR） and SpO2 during the anesthesia induction phage, maintenance phage and analepsia phage, the recovery time of spontaneously breathing and consciousness from withdrawal, extubation time, pain score（verbral report score, VRS） and conscious state score （observers assessment of alertness/ sedation scale, OAAS） at instant, 1 h, 3 h, 7 h, 12 h after extubation and complications of analepsla phage were recorded. Results As compared with the RF Group, the F Group and pre-induction intro-group, the R Group showed lower MAP and quicker HR when induction intubation, higher MPA and quicker HR after operation, and no obvious difference in maintenance phage was found. MAP and HR showed no obvious difference between the RF and F Group as well as within groups in induction and maintenance phage. MAP increased and HR became quicker in the RF Group when extubating and leaving operating room. All observed index at every time showed no significant differences between the R and RF Group after operation, but it prolonged significantly in the F Group. Complications of the three groups showed no statistical difference. VRS of the R Group was significantly higher than that of RF and F groups after operation（P 〈 0.0! ）;as compared with instant after extubation, VRS score increased significantly in the R Group, but there was no obvious variation in RF and F groups. OAAS of instant after extubation and at 1, 3 h postoperatively in the F Group were lower significantly than those of R and RF groups （ P 〈 0.0! ）. Conclusions As compared with simple infusion of remifentanil or fentanyl, intravenous propofol anesthesia combined with remifentanil and fentanyl in induction phage and maintaining anesthesia with remifentanil have more stable anesthesia effect without influencing quality of recovery from anesthesia obviously and less postoperative complications, and can decrease requirement of postoperative analgesia.