靶控输注瑞芬太尼伍用丙泊酚或七氟醚在妇科腹腔镜手术中的麻醉效果比较

Comparative Study of Target Controlled Infusion of Remifentanil Combined with Propofol or Sevoflurane Anesthesia in Gynecological Laparoscopy Operation

[目的]比较靶控输注瑞芬太尼与丙泊酚全凭静脉麻醉和靶控输注瑞芬太尼与七氟醚静吸复合麻醉在妇科腹腔镜术中的麻醉效果.[方法]选择ASAⅠ或Ⅱ级择期行妇科腹腔镜手术患者52例,随机均分为瑞芬太尼-丙泊酚全凭静脉麻醉组（RP组）与瑞芬太尼-七氟醚静吸复合麻醉组（RS组）.RP组麻醉维持用瑞芬太尼与丙泊酚靶控输注,RS组采用靶控输注瑞芬太尼及吸入七氟醚维持麻醉.观察和测定麻醉前10 min（T0）、插管后1 min（T1）、气腹后15 min（T2）及停气腹后15 min（T3）4个时间点的平均动脉压（MAP）、心率（HR）、血糖（BG）、皮质醇（Cor）,并记录两组患者术毕停药后自主呼吸恢复时间、呼之睁眼时间、拔管时间及定向力恢复时间.术后24 h 随访恶心、呕吐、躁动发生率,有无术中知晓以及患者满意度.[结果]两组4个时间点的MAP、HR、Cor、BG组间比较差异无统计学意义（P〉0.05）;组内比较,两组MAP、HR在T1、T2两时点与T0比较均下降（P〈0.05）,两组Cor在T2、T3与T0时点比较均明显下降（P0.05）.两组均无术中知晓,RS组的恶心、呕吐例数多于RP组（P〈0.05）.患者术后满意度均为100%.[结论]靶控输注瑞芬太尼复合丙泊酚或七氟醚用于妇科腹腔镜手术,均能维持术中血流动力学稳定以及较好的抑制插管和气腹造成的应激反应,术后苏醒迅速,尽管RS组术后恶心、呕吐多于RP组,但两种方法均能被病人较好的接受.

[Objective] To compare the efficacy of intravenous anesthesia with target controlled infusion of remifentanil and propofol vs inhalation combined anesthesia with target controlled infusion of remifentanil and sevoflurane in gynecological lapa- roscopic surgery. [Methods] Totally 52 ASA I or 11 patients scheduled for gynecological laparoscopic surgery were randomly divided into remifentanil-propofol target controlled infusion intravenous anesthesia group（group RP） and remifentanil-sevoflu- rane inhalation combined anesthesia group（group RS）. Group RP was given remifentanil and propofol target controlled infusion for the maintenance of anesthesia. Group RS was given remifentanil target controlled infusion and sevoflurane inhalation for the maintenance of anesthesia. Mean arterial pressure（MAP）, heart rate（HR）, blood glucose（BG） and cortisol（Cor） at 10min before anesthesia（T0）, lmin after intubation（T1 ）, 15min after pneumoperitoneum with CO2 （T2） and 15min after the end of pneumoperitoneum（T3） were observed and measured. The time of spontaneous breath, eye opening, extubation and restoration of orientation were recorded after drug withdrawal and operation. The incidence of nausea, vomiting and restlessness, intraoperative consciousness and patientssatisfaction were followed up at 24h after operation. [Results] There was no significant difference in MAP, HR, Cor and BG at four time points between two groups（ P 〉0.05）. Compared with T0, MAP and HR at T1 and T2 decreased（ P 〈0.05）, and Cor at T2 and T3 decreased significantly（ P d0.01）. Compared with group RP, the time of spontaneous breath, eye opening, extubation and restoration of orientation in group RS decreased, but there was no significant difference（ P 〈0.05）. No intraoperative consciousness occurred in both groups. The incidence of nausea and vomiting in group RS was higher that in group RP（ P 〈0.05）. Patients satisfaction of two groups was 100%. [Conclusion] Target con- trolled infusion of remifentanil combined with propofol or sevoflurane anesthesia in gynecological laparoscopic surgery can main- tain the stable hemodynamics and better inhibit the stress response caused by intubation and pneumoperitoneum, and have rapid recovery of consciousness. Although postoperative nausea and vomiting in group RS is more than that in group RP, both anesthesia methods can be accepted by patients.