丙泊酚复合雷米芬太尼靶控输注对老年腹腔镜胆囊切除术的麻醉观察

Application of target-controlled infusion of propofol combined with remifentanil in the elderly patients undergoing laparoscopic surgery

目的比较雷米芬太尼联合丙泊酚靶控输注静脉麻醉与静脉＋吸人复合麻醉在老年患者腹腔镜胆囊切除手术中的血流动力学变化及不良反应。方法选择老年择期腹腔镜胆囊切除术患者56例，ASAⅠ-Ⅱ级，随机分为雷米芬太尼联合丙泊酚靶控输注麻醉28例（观察组）和静脉＋吸入异氟醚维持麻醉28例（对照组）。分别于各时点记录患者的HR、SBP、DBP、PzrCO2、初醒时间、拔管时间和拔管后10min OAAS评分及术后24h的恶心、呕吐及嗜睡情况。结果观察组SBP、DBP及HR变化小于对照组；初醒时间、拔管时间和拔管后10min OAAS评分观察组均优于对照组（均P〈0．05）。而且观察组术后发生恶心、呕吐的患者明显较对照组均减少（均P〈0．05）。结论老年患者腹腔镜胆囊切除手术中丙泊酚复合雷米芬太尼靶控输注麻醉比静吸复合全麻能够更好的抑制应激反应，较容易维持循环稳定，且术后恢复快，不良反应更少，是老年患者腹腔镜胆囊切除术的理想麻醉方法。

Objective To compare target-controlled infusion of propofol combined with remifentanil total intravenous anesthesia and intravenous combined with inhalation anesthesia in hemodynamie changes and side effects in elderly patients with laparoseopic cholecysteetomy. Methods 56 ASA Ⅰ - Ⅱ patients aged 〉 60 y undergoing elective laparoseopie eholeeystectomy were randomly divided into propofol-remifentanil target controlled infusion group （ observation group） （ n = 28 ） and inhalation anesthesia group （ using intravenous anesthesia was maintained with isoflurane inhalation） （ n = 28 ）. HR, SBP, DBP, PETCO2, initial consciousness time, extubation time, side-effects were recorded at each time points. Results The change extent of HR and blood pressure in observation group was lower than inhalation anesthesia group. The initial recovery time, recovery time of spontaneous breathing and extubation time in the observation group was better than anesthesia group （all P 〈 0.05 ）. The side-effects in observation group were significantly lower than inhalation anesthesia group （ all P 〈 0.05 ）. Conclusion Laparoscopic cholecystectomy in elderly patients by target-controlled infusion of propofol combined with remifentanil total intravenous anesthesia could significantly inhibit the stress response, and effectively maintain the stability of hemodynamic, and rapid postoperative recovery ,fewer adverse reactions. It was an ideal anesthesia methods in elderly patients with taparoscopie cholecystectomy.