靶控输注异丙酚复合瑞芬太尼对腹腔镜胃肠手术应激反应的影响

Stress response of target-controlled infusion of propofol and remifentail during laparoscopic surgery

目的观察靶控输注异丙酚复合瑞芬太尼用于腹腔镜胃肠手术对应激反应的影响。方法选择ASAⅠ～Ⅱ级择期在全麻下行腹腔镜胃肠切除术患者40例,随机分为两组,每组20例。靶控输注组（T组）：靶控输注异丙酚复合瑞芬太尼诱导和维持;静吸复合组（Ⅰ组）：常规诱导后静吸复合维持麻醉。两组间断静注维库溴胺维持肌松。观察基础值（T0）、气管插管即刻（T1）、气腹前5min（T2）、气腹后10min（T3）、气腹后60min（T4）、结束气腹后10min（T5）各时点的HR、SBP、DBP,抽血查血糖、肾上腺素和去甲肾上腺素、皮质醇的浓度。结果T组在各时点HR、SBP、DBP无统计学差异（P〉0.05）,Ⅰ组在插管、气腹后明显升高（P〈0.05）。T组在T3、T4、T5血糖、肾上腺素和去甲肾上腺素、皮质醇较T0有所升高,但明显低于Ⅰ组（P〈0.05）。结论靶控输注异丙酚复合瑞芬太尼用于腹腔镜胃肠手术安全可行,可有效抑制手术刺激引起的应激反应,术中血流动力学稳定。

Objective To observe the effects on stress response of the patients undergoing laparoscopic surgery through comparing target-controlled infusion（TCI） with propofol and remifentanil with combined intravenous inhalation anesthesia. Methods Forty ASA Ⅰ～ Ⅲ patients undergoing elective laparoscopic gastrectomy or intestinectomy surgery were randomly divided into two groups： group T underwent intravenous TCI of propofol and remifentanil（ n = 20） and group I underwent combined intravenous inhalation anesthesia （ n = 20）. The muscular relaxation was maintained by intermittent boluses of vecuronium. HR,SBP.DBP and the plasma glucose concentration, epinephrine, norepinephrine and cortisol were mesured before induction（T0）, immediately after tracheal intubation（T1）, at 5rain before pneumoperitoneurn （T2）, at 10min after pneumoperitoneum （T3）, at 60min after pneumoperitoneum （T4） and at 10rain after cease pneurnoperitoneum （ T5 ）. Results HR, SBP, DBP in group T were no significant difference at every point （ P 〉 0.05）, and significant differences were found at T1, T2,T3, T4, T5compared with point To（P〈0.05） in group Ⅰ. The plasma glucose concentration,epinephrine, norepinephrine and eortisol increased signifisently at T3, T4, T5 in group T, but were significantly less than that in group Ⅰ（ P 〈 0.05）. Conclusion Target-controlled infusion （TCI） restrains stress response effectively and maintains the hemodynamic stabilization response.