靶控输注异丙酚复合瑞芬太尼静脉麻醉在腹腔镜下肾囊肿去顶术中的应用研究

Target-controlled infusions of propofol and remifentanil in retroperitonea laparoscopic for renal cyst

目的:评价靶控输注异丙酚复合瑞芬太尼静脉麻醉在腹腔镜下肾囊肿去顶术中的效果。方法:腹腔镜下肾囊肿去顶手术患者30例,随机分为微量泵输注异丙酚-瑞芬太尼组(I组n=15例)和异氟醚组(Ⅱ组n=15例)。观察围术期两组血流动力学变化,入室至麻醉苏醒期间持续监测动脉收缩压(SBP)、舒张压(DBP)、心率(HR)、氧饱和度(SpO2);两组患者术后恢复情况。结果:两组中T1、T2、T3和T4的SBP、DBP、HR值与基础值(T0)相比,均显著下降(P<0.05);气腹后T2、T3时点Ⅱ组SBP、DBP、HR值均高于I组,Ⅱ组气腹毕(T4)SBP、DBP高于I组(P<0.05),I组术中各时段血压与诱导前相比低且平稳;Ⅰ组患者术后自主呼吸恢复时间、睁眼时间及拔管时间较Ⅱ组明显缩短(P<0.05)。结论:靶控输注异丙酚复合瑞芬太尼麻醉用于腹腔镜下肾囊肿去顶手术,血流动力学稳定,苏醒迅速有效且安全。

Objective To evaluate the anesthetic effects of retroperitonea laparoscopic for renal cyst by infusing propofol and remifen- tanil with minimum pump. Method A total of 30 ASA physical status Ⅰ and Ⅱ patients undergoing retroporitonea laparoscopic for renal cyst operations from 2006 to 2008 were randomly divided into 2 groups（ n = 15 each） ,group I of propofol and remifentanil pumped via target - controlled infusion and group Ⅱ of regular intravenous -inhalation combination. Hemodynamic variables including SBP, DBP, HR, and SpO2 were monitored by bemodynamic monitors in all the patients. Results Compared with the baseline values ,the SBP, DBP, HR values of the two groups were decreased significantly（ P 〈0.05 ） at T1 ,T2 ,T3 and T4 measure points. The values of SBP,DBP,and HR in group Ⅱ were higher than those of group Ⅰ at T2 and T3, and the values of SBP and DBP in group Ⅱ were higher than those of group Ⅰ （ P 〈 0. 05 ） at T4 （after pneumoperitoneum）. Compared with blood pressure before anesthesia inducing,blood pressures at all the measure points during the operation were low and stable in group Ⅰ. The interval between the termination of anesthetics and the full recovery of spontaneous breathing, eye opening at request and tracheal extubation in group Ⅰ were significantly shorter than those of group Ⅱ （ P 〈 0. 05 ）. Conclusion Comparing to the regular intravenous inhalation anesthesia, the anesthetic induction by target - controlled infusing propofol and remifentanil is more effective and safe in retroperitonea laparoscopic for renal cyst operations, and has more stable perioperative hemodynamies and quick analepsia.