静脉吸入复合全身麻醉在腹腔镜胆囊切除术中的应用

Application of remifentanil combined with sevoflurane anesthesia to laparoscopic cholecystectomy

目的观察雷米芬太尼-七氟醚复合全身麻醉(全麻)与雷米芬太尼-丙泊酚全凭静脉麻醉在腹腔镜胆囊切除术中的应用。方法40例择期行腹腔镜胆囊切除术的患者,ASAI或II级,随机分为雷米芬太尼-七氟醚组(S组)和雷米芬太尼-丙泊酚组(P组),每组20人。以咪唑安定0.1mg/㎏、雷米芬太尼1μg/(kg·min)、丙泊酚2.0mg/kg、罗库溴铵0.6mg/kg做麻醉诱导后气管插管;麻醉维持为S组3%～4%七氟醚吸入和0.5μg/(kg·min)雷米芬太尼静脉泵入,P组60～100μg/(kg·min)丙泊酚和0.5μg/(kg·min)雷米芬太尼静脉泵入。观察两组的苏醒时间、术中BP、HR的变化。结果两组苏醒时间的差异无显著性。P组中SBP、DBP、HR的波动大于S组(P<0.05)。结论雷米芬太尼-七氟醚对循环影响更小,无蓄积,适合于腹腔镜胆囊切除术。

[ Objective ] To investigate the effects of propofol/remifentanil, sevoflurane/remifemanil anesthesia in laparoseopie eholecystectomy. [ Methods ] Forty ASA Ⅰ or Ⅱ patients undergoing laparoscopic cholecysteetomy were randomly divided into two groups： propofol group （n =20, group P） and sevoflurane group （n =20, group S）, these cases were induced with midazolame 0.1 mg/kg, rcmifentanil 4μg/（kg·min）, propofol 2.0 mg/kg, rocuronium 0.6 mg/ kg. After rapid induction all patients were intubated with a tube. Anesthesia was maintained with continuous infusion of 3%-4% end-tidal concentration of sevoflurane and remifentanil 0.5 μg/（kg·min） in group S, propofo160-100 μg（kg·min） and rcmifentanil 0.5 μg/（kg·min） in group P. The recovery time, BP and HR in both groups were observed. [Results] There was no statististical difference in recovery time between the groups. The changes of SBP, DBP and HR were more obvious in group P than those in group S （P 〈0.05）. [ Conclusion] The short action and rapid recovery characteristics of remifentanil combined with sevoflurane anesthesia is suitable for laparoscopie cholecystectectomy.