瑞芬太尼靶控输注在腹腔镜胆囊术中的效果研究

The Effect of Target Controlled Infusion of Remifentanil in the Case of Operation on Gallblader via Abdominal Speculum

目的：观察比较靶控输注瑞芬太尼复合丙泊酚全凭静脉麻醉与传统静吸复合麻醉抑制腹腔镜胆囊切除手术所致的应激反应的效果及血流动力学变化。方法：ASAⅠ～Ⅱ级择期行腹腔镜胆囊切除手术患者80例，随机分为2组，每组40例。Ⅰ组术中麻醉维持瑞芬太尼靶控浓度4ng／ml，丙泊酚靶控浓度3mg／ml，Ⅱ组术中维持吸入异氟醚1～1．5MAC。观察麻醉前10min（A1）、插喉罩后即时（A2）、气腹后10min（A3）、术毕解除气腹后20min（A4）时的血压、心率、血糖；术毕停药后患者呼之睁眼时间，拔管时间，气腹时间及躁动。结果：平均动脉压（MAP）、心率（HR）、血糖麻醉前和插喉罩后即时两组间差异无统计学意义，A3时点Ⅰ组均明显低于Ⅱ组（P〈0．05），术毕A4点两组差异无统计学意义，Ⅰ组在睁眼时间、拔管时间、躁动方面明显少于Ⅱ组（P〈0．01），气腹时间两组无差异。结论：瑞芬太尼复合丙泊酚全凭静脉麻醉能较好抑制腹腔镜胆囊切除手术所敛的应激反应及血流动力学变化，且苏醒质量好，恢复快。

Objective：To observe and compare the effect of the stress reaction and the changes of haemodynamics after the laparoscopic cholecystectomy operation by the use of two kinds of anesthetizatious： vein anesthesia via the target controlled infusion of remifentanil and propofol and the traditional combined anesthesia by vein infusing. Methods： 80 patients who were to receive the operation of laparoscopic chotecystectomy on schedule and were divided into 2 groups equally and randomly. During the operation in group 1 the densities of remifentanil and propofol were 4ng/ml and 3mg/ ml, respectively. While the dose of isoflurane to group If was 1 - 1.5MAC. The patients＇ blood pressure, he,art rate and blood glucose ten minutes before anaesthesia（A1）, after planling laryngeal mask（A2）, 10 minutes after aeroperitoneurn（A3） and 20 minutes after operation（A4） and the time to come to life after discontinuation of drug and the time of extubation,aeroperitoneum and restlessness were observed. Results： There is no difference between the two groups in MAP, HR, blood glucose before anaesthesia and after planting laryngeal mask in the two groups. At the time A3, these items in group Ⅰ were obviously lower than that in group Ⅱ （P%0.05）, but there is no statistically significant difference between the two groups at A4 after operation. C-roup Ⅰ was lower than group Ⅱ in the time to come to life after discontinuation and the time of extubation and restlessness. The time of aeroperitoneum was the same. Conclusion：The vein anesthesia via the target controlled infusion of remifentanil and propofol can better control the stress reaction and the changes of haemodynamics after the laparoscopic choleeystectomy operatioru Furthermore, the patients can come to life completely and quickly.