摘要
目的研究瑞芬太尼复合异丙酚全凭静脉麻醉在腹腔镜胆囊切除术的应用及其效果评价。方法选择择期行腹腔镜胆囊切除手术患者100例，随机等分为静吸复合组（静吸组）和全凭静脉麻醉组（全静脉组），两组均以咪达唑仑0．1mg／kg、异丙酚2mg／kg、芬太尼2μg／kg和维库溴胺0．08～0．12mg／kg诱导后作气管插管。麻醉维持：静吸组用异氟醚吸入，间断辅以芬太尼静注；全静脉组将瑞芬太尼0．2μg／（kg·min）和异丙酚70μg／（kg·min）混合抽入50mL注射器中，用微量泵持续输注。记录麻醉诱导前、气腹前和气腹后10min、气腹毕和术毕的SBP、DBP、HR和SPOz及停止麻醉至拔管时间，拔管时的清醒程度和随访结果。结果两组间的拔管时间、清醒程度无显著性差异。静吸组在气腹后10min的HR、SBP、DBP、术毕HR明显高于基础值（P〈0．05），而全静脉组术中无明显变化。全静脉组的术后恶心、呕吐发生率明显低于静吸组。结论瑞芬太尼复合异丙酚全凭静脉麻醉用于腹腔镜胆囊切除手术，具有麻醉效果满意、血流动力学稳定、苏醒快速、术后恶心呕吐率低、无空气污染等优点。
Objective To study the application of Remifentanil intravenous narcosis with Propofolum in laparoscopic cholecystectomy and evaluate its effectiveness. Methods 100 patients who would be given choose time laparoscopic cholecystectomy has been selected,and divided into two equal groups randomly,one is intravenous injection＇combinated with aspiration （group one）,and the other is intravenous narcosis only （group two）,two groups investigated have been induced with Midazolam 0.1mg/kg,Propofolum 2mg/kg,fentanyl 2μg/kg and Vecuronium Bromide for injection 0.08-0.12 mg/kg, then take tracheal intubation. Maintenance of anesthesia： group one with Isoflurane breathe in,assisted with fentany intravenous injection intermittently; group two has been infused with the mixture of Remifentanil 0.2μg/（kg · min） and Propofolum 70μg/（kg · min） persistently, using the micro pump. Recording the SBP, DBP, HR, SPO2 of 10 minutes before anesthesia induction and aeroperitoneum, 10 minutes after aeroperitoneum,aeroperitoneum and operation finished respectively,and the time between anesthesia finished and extubate,lucidity when extubate,follow-up results. Results There are no significant differences between the two groups in the time when extubate been done and lucidity when extubate. The SBP,DBP,HR at the time of 10 minutes after aeroperitoneum and the HR of operation finished are much higher than the foundation value in group one （P〈0.05）,there are no marked change in group two. The incidence rate of postoperative nausea and emesis in group two is lower than group one. Conclusion The application of Remifentanil intravenous narcosis with Propofolum in laparoscopic cholecystectomy has many merits, such as content narcosis effect, stable haemodynamics,analepsia quickly,low incidence rate of postoperative nausea and emesis,no air pollution and so on.
