舒芬太尼复合艾司洛尔对腹腔镜胆囊切除术二氧化碳气腹期间的影响

Impact of Sufentanil Combined with Esmolol on Cardiovascular Responses and Bispectral Index during CO_2 Pneumoperitoneum in Laparoscopic Cholecystectomy

目的评价舒芬太尼复合艾司洛尔对腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和脑电双频指数(BIS)的影响。方法 2010年1月-2011年12月间,选择美国麻醉医师协会分级Ⅰ～Ⅱ级择期腹腔镜胆囊切除术患者90例,随机分为芬太尼组(A组)、舒芬太尼组(B组)和舒芬太尼+艾司洛尔组(C组)。A组用芬太尼4μg/kg,B、C组用舒芬太尼0.6μg/kg麻醉诱导后气管插管,机械通气;C组在气腹前加用艾司洛尔。3组均常规静脉注射咪达唑仑0.1 mg/kg、丙泊酚2 mg/kg和维库溴铵0.1 mg/kg。分别记录各组在气腹前(T1)、气腹30 s(T2)、气腹5 min(T3)、气腹15 min(T4)时的收缩压、舒张压、平均动脉压、心率、血氧饱和度和BIS值。结果 T1时C组收缩压、舒张压、心率、BIS值最低,各组间差异无统计学意义(P>0.05);T2、T3、T4时A组收缩压、舒张压、心率、BIS明显增加,B组有所上升,ⅢC组各时段变化不明显。A组与B组、B组与C组间差异有统计学意义(P<0.05)。结论舒芬太尼复合艾司洛尔能更好地预防腹腔镜胆囊切除术二氧化碳气腹期间心血管反应和抑制BIS的增加。

Objective To evaluate the impact of sufentanil combined with esmolol on cardiovascular responses and bispectral index（BIS） during CO2 pneumoperitoneum in laparoscopic cholecystectomy.Methods From January 2010 to December 2011,90 elective laparoscopic cholecystectomy patients with ASA gradeⅠ-Ⅱwere randomly divided into the fentanyl group（groupⅠ）,sufentanil group（groupⅡ） and sufentanil combined with esmolol group（groupⅢ）.Endotracheal intubation and mechanical ventilation were performed after patients in group I used fentanyl（4 μg/kg）,and groupⅡand Ⅲ patients used sufentanil（0.6 μg/kg） to induce anesthesia.Patients in groupⅢused esmolol before pneumoperitoneum was established.Patients in all the three groups were regularly administered midazolam（0.1 mg/kg）,propofol（2 mg/kg） and vecuronium（0.1 mg/kg） through intravenous injection.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,heart rate（HR）,oxygen saturation（SpO2） and BIS at the moment of T1（before establishing pneumoperitoneum）,T2,T3 and T4（separately at 30 seconds,5 minutes and 15 minutes after establishing pneumoperitoneum） in each group were recorded and analyzed.Results At T1,the SBP,DBP,HR and BIS of groupⅢ patients were the lowest in the three groups,but the differences were not significant among the three groups（P0.05）.At T2,T3,and T4,the SBP,DBP,HR and BIS significantly increased in groupⅠ,increased in groupⅡand did not significantly change in groupⅢ.There were significant differences between group I and groupⅡ,and between groupⅡand groupⅢ（P0.05）.Conclusion Sufentanil combined with esmolol can be better to prevent laparoscopic cholecystectomy cardiovascular responses during CO2 pneumoperitoneum and inhibit the increase in BIS.