七氟醚低流量紧闭麻醉在腹腔镜胆囊切除术的应用

Sevofrane general anesthesia by low - flow closed - circuit used in laparoscopic cholecystectomy

目的对比观察雷米芬太尼和七氟醚全身麻醉在腹腔镜胆囊切除手术时，对患者循环功能的影响及苏醒时的不良反应。方法将70例腹腔镜下胆囊切除手术患者，随机分为雷米芬太尼组（R组）和七氟醚组（S组），每组35例，R组以雷米芬太尼、丙泊酚维持麻醉；S组应用七氟醚低流量紧闭循环吸入维持麻醉，观察两组患者气腹前、气腹后，气管拔管前、气管拔管后的血压和心率；观察苏醒时间，拔除气管导管时的不良反应，术中疼痛及术后恶心、呕吐发生率。结果两组患者的苏醒时间，拔除气管导管时的不良反应，术后恶心、呕吐发生率比较差异无统计学意义；两组患者收缩压在气腹前及气腹后5、10min均较麻醉前显著降低，但R组下降更明显；R组的心率在气腹前及气腹后5、10min均较麻醉前显著降低（P〈0．01）。结论雷米芬太尼和七氟醚均适用于腹腔镜胆囊切除手术，但七氟醚对循环的抑制小，更安全。

Objective To contrast the remifentanil with sevofrane used in general anesthesia in laparoscopic cholecystectomy to patients＇ circulation function and side reactions when they woke up. Methods Seventy laparoscopie eholecystectomy patients were divided into remifentanil group and sevofrane group, and 35 patients each. Remifentanil group used remifentanil and propofol to maintain anesthesia, sevofrane group used low - flow sevofrane closed - circuit to maintain anesthesia, observed the patients＇ BP and HR deference before and after building pneumoperitoneum 5,10 rain and before and after extubate trached cannula 5,10 min and also observed the patients＇ palinesthesia time, adverse reactions when extubate trached eannula, pain and perception in operation and the nausea and vomiting rate after operation. Results The patients ＇ palinesthesia time, adverse reaction when extubate trached cannula, pain and perception in operation and the nausea and vomiting rate after operation between the two groups had no statistics deference. The patients＇ systolic pressure before and after building pneumoperitoneum 5,10 min in two groups remarkably declined, but the remifentanil group declined more. The HR in remifentanil group before and after building pneumoperitoneum 5,10 rain all remarkably declined contrast to proanethesia（ P 〈 0.01 ）. Conclusions Remifentanil and sevofrane all fit laparoscopic cholecystectomy, but sevofrane has less restraint to circulation and more safer.