不同麻醉方式对腹腔镜下胆囊切除术老年患者血流动力学及应激反应的影响

Hemodynamics and Stress Response Change with Different Anesthesia for Laparoscopic Cholecystectomy in Elderly Patients

目的探讨不同麻醉方式对腹腔镜下胆囊切除术老年患者血流动力学及应激反应的影响。方法选择66例患者,均分为静脉组(33例)和吸入组(33例),常规诱导插管后,静脉组给予丙泊酚3μg/mL靶控输入,吸入组使用1%～3%七氟醚,并根据患者体重和手术进展泵入瑞芬太尼和维库溴铵,对不同时点循环功能和应激指标进行监测。结果 静脉组在手术结束后10min MAP低于吸入组(P<0.05),CVP在手术后10min和手术后30min低于吸入组(P<0.05),CI在手术后30min低于吸入组(P<0.05),静脉组在手术后10min血糖高于吸入组(P<0.05),去甲肾上腺素在手术后10min、手术后30min和手术结束后10min高于吸入组(P<0.05),皮质醇在手术后30min和手术结束后10min高于吸入组(P<0.05)。结论对于老年患者行腹腔镜下胆囊切除术,使用七氟醚维持麻醉较丙泊酚更能维持患者循环稳定,减少患者应激反应。

Objective To investigate the hemodynamics and stress response change with different anesthesia for laparoscopic cholecystectomy in elderly patients. Methods 66 patients were divided into the vein group （33 cases） and inhalation group （33 cases）. After intubation,the vein group received TCI of propofol 3μg/mL, sevoflurane inhalation with 1% - 3% according to patient weight and surgery;Fentany and remifentanil pump for circulatory in different time and stress indicators for monitoring were used. Results 10min after surgery, MAP of the vein group was lower than inhalation group （P〈0.05）;10 and 30min after surgery, CVP were lower than inhalation group （P〈0.05）;30min after surgery, CI was higher than inhalation group （P〈0.05）;10min after surgery, glucose of the vein group was lower than inhalation group （P〈0.05）;10min and 30min after surgery, norepinephrine of the vein group were higher than inhalation group （P〈0.05）;Cortisol in 30min and surgery after surgery were higher than inhalation group （P〈0.05）. Conclusion Anesthesia maintained with sevoflurane compared with propofol for elderly patients with laparoscopic cholecystectomy, intraoperative circulation maintains stability and it can reduce the stress response in patients.