丙泊酚复合瑞芬太尼全凭静脉麻醉与腰硬联合麻醉用于腹腔镜妇科手术的比较

Propofol-Remifentanil intravenous anesthesia in gynecological surgery:compared with combined epidural spinal anesthesia

目的比较丙泊酚、瑞芬太尼全凭静脉麻醉与腰硬联合麻醉应用于妇科手术的麻醉效果,及其安全性与可行性。方法选择择期行妇科腹腔镜手术的患者50例,随机分为丙泊酚瑞芬太尼静脉全麻组(Ⅰ组)25例和腰硬联合麻醉组(Ⅱ组)25例。Ⅰ组静注芬太尼3μg/kg、丙泊酚1.5～2mg/kg、阿曲库铵0.5～1mg/kg诱导插管,然后用微泵持续注射丙泊酚(6～10)mg/(kg.h),瑞芬太尼0.5μg/(kg.min),30～45min间断静注阿曲库铵(0.25～0.5)mg/kg维持麻醉。Ⅱ组采用腰硬联合阻滞麻醉。记录血压、脉搏、SpO2以及术中牵拉反射、肌松效应及手术时间、术中液体入量及麻黄素的使用量。结果平均手术时间Ⅱ组(78.8±9.3)min,比Ⅰ组(62.3±6.7)min延长(P<0.05)。Ⅱ组术中液体入量为(1172.3±210.7)ml,明显多于Ⅰ组(823.3±140.7)ml(P<0.05)。Ⅱ组使用麻黄素患者18例(72%),显著多于Ⅰ组(5例,25%)(P<0.05)。Ⅰ组肌松及镇痛效应明显优于Ⅱ组,牵拉反应明显小于Ⅱ组。结论丙泊酚与瑞芬太尼静脉全麻用于腹腔镜妇科手术,具有起效快,苏醒快的特点,麻醉效果确切,无严重不良反应,优于腰硬联合阻滞麻醉。

Objective To compared the anesthetic effects,the safety of propofol-remifentanil total intravenous anesthesia in gynecological patients with the combined epidural spinal anesthesia. Methods Fifty patients scheduled for gynecological surgery were randomly divided into two groups, the group Ⅰ patients received propofol-remifentanil anesthesia （ n = 25 ）, and the group Ⅱ undergoing combined epidural spinal anesthesia （ n = 25 ）. The intraoperative blood pressure, pulse rate, the saturation of pulse oxygenation were recorded, the strain reflex, muscular relax effects, the time of operation, the volume of liquid infusion and the doses of ephedrine were also recorded intraoperatively. Results The patients in group Ⅱ underwent longer operation time and received more liquid and ephedrine infusion than that of group Ⅰ （ P 〈 0.05 respectively ）while the muscle relax and analgesic effects was superior in group Ⅰ patients. The strain reflex was also mild in group Ⅰ . Conclusion Propofol-remifentanil anesthesia is superior to combined epidural spinal anesthesia in gynecological surgery, with the advantages of rapid onset and recovery, good anesthetic effects and no severe complications.