腹腔镜手术临床麻醉研究

Peritoneoscope surgery clinical anaesthesia research

目的：对行妇科腹腔镜手术的不同年龄的患者采用瑞芬太尼、丙泊酚靶控榆注进行诱导和维持，观察此麻醉方式的临床疗效。方法：120名ASAⅠ～Ⅲ级、行择期妇科腹腔镜手术的患者，分为Ⅰ组（〈65岁）和Ⅱ组（≥65岁），每组20例。麻醉诱导，I组瑞芬太尼靶效应室浓度4ng／ml，Ⅱ组瑞芬太尼靶浓度2．5ng／ml，2组丙泊酚血浆靶浓度从2．0μg／ml逐渐升高至意识消失，气管插管后根据脑电双频指数和血流动力学参数变化调整丙泊酚和瑞芬太尼的靶浓度。记录患者诱导和维持阶段丙泊酚和瑞芬太尼靶浓度、收缩压、舒张压、心率及苏醒时间。结果：Ⅱ组患者意识消失时丙泊酚靶血药浓度明显低于I组[（2．5±0．4）μg/ml vs （3．2±0．5）μg/ml ，t=5．988，P=0.000]，维持过程中Ⅱ组平均丙泊酚靶浓度低于Ⅰ组，维持过程中Ⅱ组瑞芬太尼靶浓度明显低于Ⅰ组。2组诱导后收缩压明显下降，气管插管后回升，术中维持稳定。2组舒张压、心率的波动无统计学意义。2组血管活性药的应用倒数差异无显著性。Ⅱ组麻醉恢复时间长于Ⅰ组（P〈0．05）。结论：根据监测数据个体化地调整丙泊酚和瑞芬太尼的靶浓度，能够使行妇科腹腔镜手术老年患者的血流动力学波动范围和麻醉深度维持在与中青年近似的水平，但老年患者苏醒时间仍延长。

Objective：To gynecological laparoscopic surgery in different age of patients using Rachel fentanyl,propofol target control for induction and maintenance,infusion of this way of clinical curative effect. Methods： Ⅲ- 120 ASA I elective class and gynecologic laparoscopie surgery patients,divided into Ⅰ group （〈 65 years old） and Ⅱ groups （p） ,each group of 65 years old 20 cases. Ⅰ group narcotic induction, rui fentanyl target effect chamber 4 ng/ml, concentration Ⅱ group rui fentanyl 2.5 ng/ml target concentrations, 2 propofol group plasma concentrations of target from 2.0 muon g/ml gradually increased to consciousness after tracheal intubation, double- frequency index and according to the brain electrical changes in hemodynamic parameters adjustment propofol with fentanyl target concentrations. Record patients induction and maintenance stages propofol with fentanyl target concen- trations,systolic and diastolic blood pressure and heart rate and the awakening of time. Results： Patients consciousness Ⅱ disappeared propofol target drug concentration significantly lower than Ⅰ group [（2.5 ± 0.4） muon g/ml vs （3.2± 0.5） muon g/ml, t = 5. 988,P = 0. 000], 2 groups after induction systolic blood pressure decreased obviously, after tracheal intubation,maintain stable rise. 2 groups diastolic blood pressure, heart rate volatility was not statistically significant. Two groups of fiberobronchoscopieally blood there was no significant difference. Ⅱ group Ⅰ longer recover time anesthesia group （P 〈 0.05）. Conclusion： According to the monitoring data of customized to adjust the propofol with fentanyl target concentrations, can make the trip in older patients lapsroscopic surgical gynecological hemodynamic fluctuating range and depth of anaesthesia in young and middle--aged approximatc level with elderly patients, but time is extended revive.