腹腔镜胆囊切除术静吸复合快通道麻醉临床观察

Clinical Observation of fast-tracking inhalation intravenous combined anesthesia in laparoscopic cholecystectomy

目的:研究全凭静脉与快通道静吸复合全麻用于腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)的临床效果。方法:选择ASAⅠ-Ⅱ级LC病人60例,随机分两组各30例,全凭静脉组(A组);快通道静吸复合组(B组)。术前和诱导用药相同,维持A组静脉输注异丙酚,间断追加芬太尼、维库溴铵。B组吸入异氟醚,不追加维库溴铵。观察平均动脉压(MAP),心率(HR),呼气末二氧化碳分压(PETCO2),血气分析,麻醉药用量,拔管时间及围术期不良反应。结果:两组MAP、HR、PETCO2、血气分析、不良反应等比较差异无显著性(P>0.05)。异丙酚(290±51与128±38)mg、维库溴铵(11.6±2.1与7.3±2.0)mg、芬太尼(0.44±0.04与0.31±0.2)mg用量、拔管时间(96±9与76±10)min,两组间差异都非常显著(P<0.01)。结论:快通道静吸复合全麻用于LC方便快捷、术中平稳、术后苏醒快、拔管早、安全效果好。

Objective：To investigate the clinical effect of fast-tracking inhalation intravenous combined anesthesia undergoing laparoscopic cholecystectomy and compare it with total intravenous anesthesia. Methods：60 ASA Ⅰ - Ⅱ patients undergoing laparoscopic cholecystectomy were randomly divided into two groups,with 30 cases in each group. Group A received total intravenous anesthesia; Group B received fast-tracking inhalation intravenous combined anesthesia. All patients were induced with the same medicine, Anesthesia was maintained with propofol.remifentanil and atracurium in group A and maintained with enflurane in group B.MAP,HR,PETCO2 and Consciousness recovery time, tracheal intubatton to extubation time and adverse reaction bypass surgery were observed.Results：The two groups showed non-significant differences in MAP、HR、PETCO2、blood gas analysis and adverse reaction （P〉0.05）, The two groups showed significant differences in the dosage of propofol （290 ±51 to 128 ±38mg） .atracurium （ 11.6 ±2.1 to 7.3 ±2.0mg）. remifentanil （0.44 ±0.04 to 0.31 ±0.2mg）and tracheal extubation time（P〈0.01）. Conclusion：Fast-tracking Inhalation intravenous combined anesthesia in laparoscopic cholecystectomy was quick and convenient,stable in surgery safe and effective,and could get a rapid recovery and pull out tube early.