瑞芬太尼联合异丙酚或依托咪酯全麻在腹腔镜妇科手术中的应用

Application of Remifentanil Combined with Propofol and Remifentanil Combined with Etomidate for General Anesthesia During Gynecologic Laparoscopy

目的:比较瑞芬太尼联合异丙酚或依托咪酯全麻在腹腔镜妇科手术中的临床效果。方法:择期腹腔镜妇科手术80例,随机分成瑞芬太尼-异丙酚组(RP组)和瑞芬太尼-依托咪酯组(RE组),各40例。两组全麻诱导用药相同,维持麻醉RP组采用瑞芬太尼联合异丙酚、RE组采用瑞芬太尼联合依托咪酯。记录基础值、诱导后、插管后1 min、3 min、气腹时、气腹后10、20、30、40 min的动脉收缩压(SBP)、舒张压(DBP)、心率(HR);记录停药至自主呼吸恢复、睁眼、拔除气管导管、恢复定向能力的时间;记录清醒即刻及清醒后1、2、4、8、12、16、20、24 h患者疼痛程度,采用VAS评分;记录24 h内不良反应发生情况。结果:两组SBP、DBP均在诱导后明显低于基础值(P<0.01),插管后恢复,气腹开始后趋于平稳;两组HR均在诱导后减慢(P<0.01),插管后及气腹开始时恢复。RP组自主呼吸恢复、呼之能睁眼、拔除气管导管及恢复定向能力的时间均明显短于RE组(P<0.01)。麻醉清醒即刻、清醒后1、2、4、8h VAS评分RE组明显低于RP组(P<0.05),12、16、20、24 h VAS评分两组比较无显著性差异(P>0.05)。术后发生恶心呕吐患者数RP组明显减少(P<0.05)。结论:全麻行腹腔镜妇科手术时,瑞芬太尼联合异丙酚或依托咪酯都能缓解气腹及手术引起的血流动力学变化,瑞芬太尼联合异丙酚术后苏醒快且能明显降低术后恶心呕吐的发生率,但术后疼痛较为严重。

Objective： To compare the effects of remifentanil-propofol with remifentanil-etomidate in gynecologic laparoscopy.Methods： Eighty patients undergoing selected gynecologic laparoscopy were randomly divided into two groups of 40 each： group RP and group RE.The two groups have the same anesthesia induction.Anesthesia was maintained with remifentanil-propofol in group RP or remifentanil-etomidate in group RE.SBP,DBP,HR were monitored at different time points： before anesthesia,after induction,at 1 min and 3 min after intubation,at pneumoperitoneum,at 10,20,30,40min after pneumoperitoneum.The time interval from operation end to spontaneous respiration,eyes-opening,extubation,orientation and VAS scores of extubation,1,2,4,8,12,16,20,24 hour after extubation were recorded.Record the incidence of untoward effect within 24 hours.Results： In the two groups,SBP and DBP decreased after induction（P〈0.01）,and were stable after pneumoperitoneum.HR were slow after induction（P〈0.01） but recovered after intubation.The time interval from operation end to spontaneous respiration,eyes-opening,extubation,orientation were remarkably shorter in group RP than those of group RE（P〈0.01）.The VAS scores of extubation,1,2,4,8 hour after extubation were higher in group RP than those of group RE（P〈0.05）.Patients with PONV in group RP were significantly less than that in group RE（P〈0.05）.Conclusion： General anesthesia with remifentanil combined with propofol or etomidate for gynecologic laparoscopy all can alleviate the change of haemodynamics caused by pneumoperitoneum and operation.Group RP has fast conscious recovery and less side effect of PONA but it has more serious pain within 8 hours.