丙泊酚靶控输注全凭静脉麻醉在腹腔镜手术中的应用

The Application of TIVA With Propofol by TCI During Laparoscopy Operation

目的：观察靶控输注丙泊酚全凭静脉麻醉应用于腹腔镜手术诱导及维持中血流动力学的变化、术后苏醒时间及相应的血浆浓度，为临床合理用药提供参考。方法：35例择期行腹腔镜手术患者采用靶控输注丙泊酚全凭静脉麻醉，设定诱导血浆靶浓度为3μg／ml，复合芬太尼2μg／kg，维库溴铵0．1mg／kg，气管插管，术中维持丙泊酚血浆靶浓度为2～4μg／ml，记录诱导前、诱导后2min、插管即刻、插管后1min、插管后5min及气腹完毕时心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、停药后苏醒时间及苏醒时相应的血浆浓度。结果：插管即刻HR、SBP、DBP及MAP与诱导前比较均有显著差异（P〈0．05），气腹完毕时SBP、DBP、MAP也较诱导前有明显升高（P〈0．05），平均苏醒时间为（8．9±3．1）min，相应血浆靶浓度为（1．27±0．32）μg／ml。结论：采用靶控输注丙泊酚全凭静脉麻醉诱导时和维持期血流动力学较为稳定，术后苏醒较为迅速，是安全满意的麻醉方法之一。

Objective：To investigate the change of hemodynamic in application of propofol by TCI during induction of anesthesia of laparoscopy operation so as to provide reference for clinical medication. Methods：35 patients Undergoing elective laparoscopy operations, accepted propofol by TCL Anesthesia was induced with TCI propofol 3μg/ml, fentanyl 2μg/kg, vecuronium 0. 1μg/kg. After orotracheal intubation, the plasma concentration of propofol by T CI maintained at a level of 2-4μg/ml. The HR, SBP,DBP and MAP before induction, 2min after induction, during intubation, 1 and 5 rain after intubation and the time after artificial pneumoperitoneum, the time of revival after ending medication and the related plasma concentration of propofol at the revival time were observed and recorded. Results. Remarkable difference were found in HR, SBP, DBP and MAP during and before induction（P〈0. 05）, and SBP, DBP and MAP increased more obviously just after artificial pneumoperitoneum than that before induction （P〈0. 05）, the average time of revival was （8. 9± 3. 1） rain, and the related plasma concentration was （ 1.27 ±0. 32 ）μg/mL Conclusion： Propofol by TCI may show the stable hemodynamic during induction and maintenance of anesthesia of laparoscopy operation and rapid revival after operation,which is one of safe and content method of total anesthesia.