七氟烷或异丙酚复合瑞芬太尼麻醉对腹腔镜胆囊切除术血流动力学的影响

Effects of Sevoflurane-remifentanil and Propofol-remifentanil Anesthesia on Hemodynamics during Laparoscopic Cholecystectomy

目的比较七氟烷-瑞芬太尼、异丙酚-瑞芬太尼复合麻醉对腹腔镜胆囊切除术血流动力学的影响。方法30例ASAⅠ-Ⅱ级择期行腹腔镜胆囊切除术的患者,经同种方法诱导后,按麻醉维持方法不同随机分为七氟烷-瑞芬太尼组（S组）和异丙酚-瑞芬太尼组（P组）,每组15例。在持续静脉输注10μg·kg-·1h-1瑞芬太尼的基础上,S组复合吸入2%-3%七氟烷,P组复合静脉输注4-6mg·kg^-1·h^-1异丙酚。采用BioZ.com监测仪测定气腹前后各时点的血流动力学指标,包括心率（HR）、平均动脉压（MAP）、心输出量（CO）、每搏输出量（SV）、外周血管阻力（SVR）、加速指数（ACI）、左心做功指数（LCWI）。手术结束即刻停用所有麻醉药,观察术后苏醒情况。结果气腹后两组血流动力学指标的变化趋势表现为HR、MAP、SVR、LCWI升高,CO、SV、ACI下降,放气后各指标与气腹期相比有所恢复,所有指标在各时点的组间比较差异均无统计学意义。与气腹前比较,HR、LCWI、ACI在两组均无显著变化;MAP在两组均显著升高（P〈0.05）,但S组的波动幅度较小;CO、SV、SVR在P组显著变化（P〈0.05）,但在S组差异无显著性。两组患者的术后苏醒情况差异无统计学意义。结论在复合瑞芬太尼的基础上,七氟烷和异丙酚对腹腔镜胆囊切除术血流动力学的影响趋势一致,但七氟烷更有利于气腹中血流动力学的稳定,并且两种麻醉方法的苏醒情况差异无显著意义。

Objective To compare the effects of sevoflurane-remifentanil and propofol-remifentanil anesthesia on hemodynamics during laparoseopic cholecystectomy. Methods Thirty patients （ASA Ⅰ - Ⅱ ） scheduled for laparoscopic cholecystectomy were induced by the same method and randomly assigned to receive sevoflurane-remifentanil （group S） or propofol-remifentanil （group P） for maintenance of anesthesia. The patients inhaled sevoflurane of 2% to 3% in group S and were infused with propofol at the rate of 4 to 6 mg·kg^-1·h^-1 in group P,with the continuous infusion of remifentanil at the rate of 1 0 μg·kg^-1· h^-1. Hemodynamic parameters, including heart rate （HR）, mean arterial pressure （MAP）, cardiac output （ CO ）, stroke volume （ SV ）, systemic vascular resistance （ SVR ）, acceleration index （ACI）, and left cardiac work index （LCWI）,were measured with CardioDynamics BioZ.com System at different thne points before and after pneumopefitoneum. At the end of surgery, all the anesthetics were stopped, and the awakening condition was observed. Results In both groups, HR, MAP, SVR, and LCWI increased, and CO, SV, and ACI decreased after pneumoperitoueum. After destrfflation, all the hemodynamic parameters began to recover. There was no significant difference in any parameter between 2 groups at each time point. MAP significantly increased after pneumoperitoneum in both groups （P 〈 0.05 ）, but the change in MAP in group S was slighter. The changes in CO, SV, and SVR after pneumoperitoneum were significant in group P （P 〈 0.05 ）, but not significant in group S. No significant difference in awakening condition was found between 2 groups. Conclusion Combined with remifentanil,the effects of sevoflurane and propofol on hemodynamics during laparoscopic cholecystectomy are accordant,but sevoflurane is better for stable hemodynamics. The awakening conditions of these 2 anesthesia methods are similar.