雷米芬太尼-丙泊酚-芬太尼复合麻醉在老年人腹腔镜手术中的应用

Application of remifentanil-propofol-fentanyl anesthesia to laparoscopic choledocholithotomy for elderly patients

目的评价雷米芬太尼-丙泊酚-芬太尼复合全凭静脉麻醉在老年人腹腔镜胆囊切除和胆总管切开取石术中的麻醉效果。方法选择60例择期行腹腔镜胆囊切除和胆总管切开取石术的老年患者,随机分为雷米芬太尼-丙泊酚-芬太尼组(A组)和雷米芬太尼-丙泊酚-异氟醚组(B组),每组30例,观察插管前后心血管反应;记录术毕停药后患者自主呼吸恢复时间、呼之睁眼时间及拔管时间;观察拔管后即刻、拔管后20min患者意识状态;术后24h疼痛程度比较;术后追加镇痛药情况;术中知晓发生率和恶心呕吐副作用。结果患者的SBP、DBP和HR,插管前1min两组差异无显著性,在插管后1min两组差异有显著性,插管前1min与诱导前比较两组差异均有显著性,B组在插管后1min与插管前差异有显著性,A组插管后1min与插管前比较差异无显著性。术后自主呼吸恢复时间、呼之睁眼时间、拔管时间,A组明显短于B组。意识状态拔管后即刻和拔管后20minA组患者较B组患者清醒。24h疼痛程度A组与B组比较差异有显著性。术后追加镇痛药物比率和恶心呕吐发生率A组明显低于B组。两组均未出现术中知晓。结论雷米芬太尼-丙泊酚-芬太尼复合全凭静脉麻醉镇痛效果好、循环较平稳、苏醒质量较好、恶心呕吐发生率低,可安全用于老年人麻醉。

[Objective] To evaluate the effect of remifentanil-propofol-fentanyl total intravenous anesthesia in laparoscopic cholecystectomy and choledocholithotomy for elderly patients. [Methods] Sixty cases of elderly patients （ASA Ⅰ-Ⅲ） who had received laparoscopic cholecystectomy and choledocholithotomy by date, were selected and randomly divided into two groups （30 cases for each group）, namely, remifentanil-propofol-fentanyl group （group A） and remifentanil-propofol-isoflurane group （group B）. And then the cardiovascular response was observed before and after intubation. The time for recovery of patients＇ autonomous respiration, eye opening, and extubation was recorded. The conscious state, VAS after 24 hour and volume of additional analgesic of patients at the very moment of extubation and the 20th minute after extubation were observed. The frequency of intraoperative awareness and side effects （e.g. nausea and vomiting） in 24 hours after operation were also recorded. [Results] The SBP, DBP and HR of patients were not significantly different at the 1st minute before intubation and significantly different at the 1st minute after extubation between group A and group B, were significantly different between the time before intubation and 1 min after extubation in group B, and were insignificantly different between 1 min after intubation and before extubation in group A. The awareness of patients in group A was clearer than that in group B at the very moment of and 20 minutes after extubation. VAS after 24 hour in group A was significantly different from that in group B （P 〈0.05）. The side effects in group A during the intubation period were significantly weaker than those in group B （P 〈0.05）;the time for recovery of patients＇autonomous respiration, eye opening, and extubation in group A was significantly shorter than that in group B. Intraoperative awareness occurred in neither of the groups, and the incidence rate of nausea and vomiting in group A was lower than that in group B （P〈0.05）. [Conclusions] Using remifentanil-propofol-fentanyl for total intravenous anesthesia, the awakening quality is good, the blood circulation is stable, and incidence rate of nausea and vomiting is lower. Thus, remifentanil-propofol-fentanyl can be safely used in the anesthesi, a for elderly patients.