异丙酚-瑞芬太尼靶控输注对妇科腹腔镜手术病人血流动力学影响

Haemodynamic study of target effect site concentration with propofol and remifentanil anesthesia in gynecological laparoscopic surgery

目的:观察3.5μg/ml效应室浓度异丙酚联合1.5ECe50(3.6ng/ml)瑞芬太尼效应室靶控输注在妇科腹腔镜手术中对血流动力学的影响,并与吸入麻醉进行比较。方法:30例ASAⅠ级择期腹腔镜手术病人,随机分为两组,即异丙酚联合瑞芬太尼双道静脉效应室靶控输注组(PR组)及七氟烷-氧化亚氮吸入组(SN组),每组15例。监测两组病人围术期的血压、心率(HR)和BIS值;并采用CO2重吸入法测定手术期间的每搏输出量(SV)、心输出量(CO)、体循环阻力(SVR)等血流动力学参数的变化。结果:PR组15例病人血压波动均在适宜麻醉范围内,1例病人在气腹5min时心率低于50次/min而需用阿托品处理;术中PR组所有血流动力学指标均在正常范围内,SN组15例病人中有9例术中血压超出适宜麻醉范围而需静注异丙酚并加大七氟烷吸入浓度加深麻醉;PR组术中气腹15min内各时间点的血压与HR均低于SN组(P<0.05或0.01),PR组术中气腹后的CO与CI均低于SN组(P<0.05或0.01)。结论:吸入麻醉腹腔镜手术中呈高血流动力学状态,异丙酚-瑞芬太尼联合靶控输注麻醉的组合模式比传统吸入麻醉可更有效地控制麻醉和手术操作所带来的血流动力学变化。

To investigate the effects of propofol （3.5 μ g/ml）-1.5 ECe50）（3.6 ng/ml） remifentanil on hemodynamics and compare with inhalational anesthesia during gynecological laparoscopic surgery. Methods： 30 ASA class I patients undergoing gynecological laparoscopic surgery were randomly divided into two groups： targeting effect-site concertration of propofol combined with targeting effectsite concertration of remifentanil （PR group, n=15） and sevoflurane combined with nitrogen monoxide （SN group, n =15）. The hemodynamic parameters for systolic blood pressure （SP）, diastolic blood pressure （DP）, mean arterial blood pressure （MAP）, heart rate （HR）, stroke volume （SV）, cardiac output （CO）, systemic vascular resistance （SVR） and the depth of anesthesia （BIS） in two groups were measured continuously during gynecological laparoscopic surgery and around incising skin. Results： In the PR group, fluctuation of blood pressure of total patients was in the suitable range during laparoscopic surgery. Atropine was infused to one patient because of lower heart rate at the 5 min of pneumoperitoneum. In the SNgroup, propofol was infused and inhalational concentration of sevoflurane was added to nine patientsbecausethe blood pressure went beyond the determinate norm. Compared with SNgroup： At the every time in the first 15 min during pneumoperitoneum, there were significant decreases in SP, DP, MAP and HR in PR group （P〈0.05 or 0.01）. There were significant decrease in CO and CI during pneumoperitoneum in PR group （P〈0.05 or 0.01）. Conlusion： Inhalation anesthesia offered the higher hemodynamic state during gynecological laparoscopic surgery. Intravenous anesthesia of propofol （target effect-site concentration 3.5 μ g/ml） -1.5 ECe50 （target effect-site concentration 3.6 ng/ml） remifentanil is more suitable to control hemodynamic state compared with inhalation anesthesia.