丙泊酚、瑞芬太尼抑制妇科腹腔镜手术气腹反应的研究

Clinical observation of propofol and remifentanil inhibit gynecological laparoscopic pneumoperitoneum stress response

目的研究丙泊酚与瑞芬太尼单独或联合应用对妇科腹腔镜手术气腹应激反应的抑制效果。方法80例ASAⅠ～Ⅱ级行妇科腹腔镜手术的患者，随机分为丙泊酚（A）组，瑞芬太尼（B）组，丙泊酚-瑞芬太尼（C）组，对照（D）组。四组均以丙泊酚、维库溴胺、芬太尼诱导，并吸入异氟烷维持麻醉。比较各组气管插管后泵注药物前（T0），泵注药物后10分钟（T1），气腹后5分钟（T2），气腹后20分钟（T3），停气腹前（T4）的SBP、HR、SNAP指数，同时记录手术结束至患者苏醒（OAA／S评分5分）拔除气管导管的时间，术中静脉追加盐酸乌拉地尔次数。结果四组在气腹后各时点的收缩压（SBP）、心率（HR）、SNAP指数均高于气腹前（P〈0．05）。D组气腹后的SBP、HR均高于A、B、C组（P〈0．05）。气腹后的SNAP指数：A、C组患者均低于D组（P〈0．05），B组与D组比较差异无统计学意义。拔管时间C组与D组明显短于A组和B组（P〈0．05）。结论丙泊酚与瑞芬太尼单独或联合应用均可抑指妇科腹腔镜气腹的应激反应，但二者合用效果更好。

Objective The aim of the study is to determine the inhibiting effect of propofol and remifentanil does alone or in combination in women undergoing gynecological laparoscopic pneumoperitoneum stress. Methods Eighty patients with ASA Ⅰ - Ⅱ,receiving selective gynecological laparoscopic surgery were randomly divided into four groups with 20 patients each. In group A propofol were infusioned before operation, in group B remifentanil were infusioned, in group C propofol and remifentanil were infusioned, in group D nothing were infusioned as a control group. All groups anesthesia were maintained with isoflurane infusion and propofol, vecuronium, fentanyl induced. Results There were significant difference in SBP, HR,SNAP among four groups at pneumoperitoneum after were higher than before pneumoperitoneum （P 〈 0.05）. Pneumoperitoneum after the index SNAP in group D was higher than those in group A and group C（P 〈 0.05）. There was no significant difference between group B and group D, Pneumoperitoneum after the index SBP, HR in group D were significantly higher than those three groups（P〈0.05）.The time of extubation group C and D were significantly shorter than group A and group B（P 〈 0.05）. Conclusion Propofol and remifentanil does alone or in combination may refer to restrain gynecological laparoscopic pneumoperitoneum the stress reaction, but the two combined to better effect.