丙泊酚复合瑞芬太尼全凭静脉麻醉在经皮肾钬激光碎石术中的应用

Propofol-remifentanil intravenous anesthesia used in the percutaneous nephrolithotom holmium laser lithotripsy

目的观察丙泊酚复合瑞芬太尼全凭静脉麻醉用于经皮肾钬激光碎石术(PCNL)的安全性和有效性。方法择期行PCNL的患者分为异氟醚吸入全麻(Ⅰ组)和丙泊酚复合瑞芬太尼(Ⅱ组)。观察2组患者诱导前(M1)、诱导后(M2)、气管插管最高时(M3)、经皮肾穿刺(M4)、钬激光碎石期(M5)、术毕时(M6),各时段的血压和心率变化,观察患者苏醒时间、拔管时间及警觉/镇静评分(OAA/S)。结果Ⅱ组患者M2、M3、M4、M5时的SBP均低于Ⅰ组(P<0.05),其余各时间点的心率、血压变化2组比较差异无统计学意义(P>0.05);苏醒时间、拔管时间及OAA/S 2组差异有统计学意义(P<0.01)。2组诱导期发生心动过缓共7例(11.2%)。结论持续微泵输注丙泊酚复合瑞芬太尼全凭静脉麻醉可以安全有效地用于PCNL,具有患者生命体征平稳、术后苏醒迅速等优点。

To investigate the safety and efficacy of propofol combined with remifentanil in total intravenous anesthe- sia （TIVA） for the patiems with peremaneous nephrolithotomy holmium laser lithotripsy （PCNL）. Methods Sixty patients （ASA Ⅰ Ⅱ） were randomly divided into two groups： isoflurane anesthesia group （group I） and propofol combined with remifentanil anesthesia group （group Ⅱ）. The blood pressure and heart rate of two groups were compared in different time points such as before induction （M1）, after induction （M2）, endotraeheal intubation （M3）, percutaneous nephrolithotomy （M4）, holmium laser lithotripsy period （ M5 ）, and the end of surgery （ M6 ） ; Recovery time, extubation time and alertness/sedation score （ OAA/S ） were also observed. Results The systolic blood pressure in group II was lower than that in group I （ P 〈 0.05 ） at M2, M3, M4 and M5 time point; there was significant difference between these two groups in recovery time, extubation time and alertness / sedation score （P 〈 0.01 ）. In addition, seven cases of bradycardia （ 11.2% ） were observed totally during induction period. Conclusion Propofol combined with remifentanil TIVA have the advantages of stable vital signs and shorten recovery time, it is safe and effective for the patients with PCNL.