腹腔镜宫外孕术中不同浓度丙泊酚、瑞芬太尼靶控输注的麻醉效果观察

EFFECTS OF TARGET-CONTROLLED INFUSION OF PROPOFOL AND REMIFENTANIL ON LAPAROSCOPIC SURGERY OF ECTOPIC PREGNANCY

目的探讨腹腔镜宫外孕术中不同血浆浓度丙泊酚、瑞芬太尼靶控输注的麻醉效果。方法30例ASAⅠ～Ⅱ级急诊腹腔镜宫外孕手术患者,随机分为3组,分别接受不同血浆浓度的丙泊酚和瑞芬太尼,每组10例。A组:丙泊酚与瑞芬太尼血浆靶浓度分别为2.5μg/ml与8ng/ml,B组:丙泊酚与瑞芬太尼血浆靶浓度分别为3μg/ml与6ng/ml,C组:丙泊酚与瑞芬太尼血浆靶浓度分别为3.5μg/ml与4ng/ml。记录麻醉诱导前、插管前、插管后即刻、CO2气腹时、CO2气腹后5min、气腹后15min、拔管时、拔管后5min的MAP、HR。以停麻药的时间为零点计时,记录患者苏醒时间、拔管时间及警觉/镇静评分(OAA/S)。结果3组患者插管前的MAP、HR均明显低于麻醉诱导前(P<0.05),插管后至拔管时各时间点的MAP、HR与插管前的无差异。拔管后5min的MAP、HR与麻醉诱导前无差异。A组的苏醒时间、拔管时间最短,且术后苏醒质量评分最佳。B组次之,C组最长(P<0.05)。结论靶控输注丙泊酚复合瑞芬太尼全凭静脉麻醉适用于腹腔镜宫外孕手术,低浓度的丙泊酚复合高浓度的瑞芬太尼麻醉效果好,苏醒快、质量佳。

Objective To study effects of different concentration of target- controlled infusion of propofol and remifentanil on laparoscopic surgery of ectopic pregnancy. Methods 30 emergengcy patients with laparoscopic surgery of ectopic pregnancy were randomly divided into three groups to receive different concentration of target- controlled infusion of propofol and remifentanil, 10 patients in every group. Group A： concentration of propofol was 2. 5μg/ml, and the concentration of remifcntanil was 8ng/ml, Group B.. concentration of propofol was 3μg/ml, and the concentration of remifentanil was 6 ng/ml, Group C.. concentration of propofol was 3.5μg/ml, and the concentration of remifentanil was 4 ng/ml. Mean artieral pressure （MAP） and heart rate （HR） were recorded at the time intervals of pre-anesthesia, pre - intubation, intubation,intraperitoneal carbon dioxide insufflation,5min, 15min after insufflation,extubation and 5rain after extubation. The time of awakening, extubation, and the OAA/S score were recorded. Results In 3 groups, MAP and HR as the time of pre- intubation were all lower than those of pre- anesthesia （P〈0. 05） ,no significant difference was found in the comparison of MAP and HR at the time of pre- intubation, intubation,intraperitoneal carbon dioxide insufflation,5min, 15min after insufflation and extubation. There was not significant difference between the MAP and HR at 5 rain after extubation and that of pre - anesthesia. The awakening time and extubation time in group A were shortest in the 3 groups, which was a little longer in group B and the longest in group C. The awakening quality was the best in group A and the worst in group C（P〈0.05）. Conclusion Target- controlled infusion of propofol and remifentanil is better chioce for laparoscopic surgery of ectopic pregnancy, the lower concentration of propofol and higer concentration of remifentanil could get good anesthesia effect,shorter awakening time and better awakening quality.