静脉麻醉在腹腔镜胆囊切除术中的应用

A comparison of curative effect between total Intravenous Anesthesia and combined intravenous with inhalation anesthesia in patients with larparoscopic cholecystectomy

目的研究异丙酚和芬太尼全凭静脉麻醉在腹腔镜胆囊切除术中（LC）的应用及其效果。方法择期LC手术患者100例随机分为静吸复合麻醉组（A组）50例和全凭静脉麻醉组（B组）50例。记录麻醉诱导前、气腹前和气腹后10min、气腹毕和术毕的心率（HR）、收缩压（SBP）、舒张压（DBP）和脉搏血氧饱和度（SpO2）及停止麻醉至拔管的时间、拔管时的清醒程度。结果A组气腹后10min HR（96．8±13．5）次·min^-1、SBP（142．5±14．3）mmHg、DBP（93．0±14．3）mmHg均高于麻醉诱导前（82．3±12．5）次·min^-1、（129．0±21．7）mmHg、（77．3±13．5）mmHg（P〈0．05—0．01）；B组气腹后10min HR（84．0±11．0）次／min、气腹毕（76．3±9．0）次／min低于A组（96．8±13．5）次／min、（84．1±11．0）次／min（P〉0．05）；B组患者术毕睁眼时间（6．5±1．5）min、拔管时间（11．5±1．4）min、术后恶心呕吐3例、术后8hVAS值（2．8±1．1）均低于A组（10．5±2．8）min、（25．2±9．5）min、12例、（5．4±2．1）（P〈0．05）。结论全凭静脉麻醉用于LC手术麻醉效果满意。

Objective To study the application of total intravenous anesthesia（TIVA） in patients with larparoscopic cholecystectomy（LC）. Methods 100 cases with LC were randomly and evenly assigned to two groups： the combined intravenous with inhalation anesthesia（CIIA） group（ n = 50） and the TIVA group（ n = 50）. The maintain anesthesia. BP, HR and SpO2 at all stages and time for extubation,the consciousness were recorded. Results The pneumoperitoneum after 10 min HR（96. 8 ± 13.5 ）times/min,SBP（ 142. 5 ± 14.3） mmHg,DBP（ 93.0 ± 14. 3 ） mmHg in A group higher than before induction of anesthesia（82. 3 ± 12.5） times/min, （ 129. 0 ± 21.7 ） mmHg, （77.3 ± 13.5 ） mmHg（ P 〈 0. 05 ± 0. 01 ） ; The pneumoperitoneum after 10 min HR （ 84. 0 ± 11.0） fimes/min, pneumoperitoneum complete（76. 3 ±9. 0） times/min in B group lower than the（96.8 ± 13.5） times/min, （84. 1 ± 11.0） times/ min in A group（P 〉 0. 05 ） ; B group patients completed the opening time（6.5 ± 1.5 ） min,extubation time （ 11.5 ± 1.4） min,postoperative nausea and vomiting in 3 cases,after 8 h VAS value of （2. 8 ± 1.1 ） in group B were lower than the （10.5 ±2. 8） min,（25.2 ±9.5）min,12 cases（5.4 ±2. 1） in group A（t=2.411,P〈0. 05）. Conclusion The application of TIVA to LC anesthetic effect is satisfaction.