瑞芬太尼复合丙泊酚麻醉在妇科腔镜手术中的应用

Investigation of the anaesthetic effect of propofol combined with remifentanil by target-controlledinfusion during gynecological laparoscopic myomectomy

目的探讨丙泊酚复合瑞芬太尼靶控输注在妇科腹腔镜子宫肌瘤剥除术中的麻醉效果与可行性。方法选择2010年6月至2011年6月在我院择期行妇科腹腔镜子宫肌瘤剥除术的患者50例，美国麻醉医师学会分级Ⅰ、Ⅱ级，按随机数字表法随机分为两组：丙？白酚复合瑞芬太尼组25例和七氟醚复合瑞芬太尼组25例。麻醉诱导用药及方法相同。分别记录麻醉诱导前、气腹后30min、术毕和拔出气管导管后3min时的动脉收缩压、舒张压和心率，记录苏醒时间及拔管时间。结果丙泊酚组患者围术期血压平稳，各个时点的收缩压、舒张压、心率与基础值相比差异均无统计学意义（P均〉0．05），七氟醚组患者收缩压、舒张压、心率在气腹后30min及拔出气管导管后3min时明显高于基础值和丙泊酚组患者，差异均有统计学意义（P均〈0．05）。七氟醚组患者苏醒时间、拔管时间比丙泊酚组患者长，差异有统计学意义[（9．3±1．5）、（4．9±1．1）min，t=10．56，P=0．02；（12．9±2．4）、（6．8±1．2）min，t=12．36，P=0．01]。结论妇科腹腔镜子宫肌瘤剥除术采用丙泊酚复合瑞芬太尼靶控输注静脉麻醉安全可行，患者麻醉诱导平稳，术中血流动力学稳定，苏醒迅速完全，并发症少，值得临床推广。

Objective To investigate the anaesthetic effect of propofol combined with remifentanil by target-controlled infusion （TCI） used in gynecological laparoseopie myomectomy. Methods Fifty cases, who were scheduled for gynecological laparoscopic myomeetomy in our hospital from June 2010 to June 2011, was randomly divided into propofol combined with remifentanil group （n = 25 ） and inhalation anesthesia （remifentanil combined with sevoflurane） group （n = 25 ）. The heart rate and blood pressure were recorded at the time of before induction of anesthesia （ T0 ）, 30 min after carbon dioxide pneumoperitoneum, the ond of operation and 3 min after extubation. The awake time, time of extubation and surgery time were also recorded. Results The hemodynamics were kept stable in propofol combined with remifentanil group, and there were no significant difference with respect to SABP, DABP and heart rate at all time points compared with baseline （P 〉 0. 05 ） in propofol group. However, in inhalation anesthesia group, SABP, DABP and heart rate were increased significantly at 30 min after carbon dioxide pneumoperitoneum and 3 rain after extubation when compared with baseline （ P 〈 0. 05 ） and were higher than those of propofol group （ P 〈 0. 05 ） at counterpart time points. In inhalation anesthesia group, the awake time （ （ 9. 3 ± 1.5 ） rain vs （ 4. 9 ± 1.1 ） min, t = 10. 56, P = 0. 017 ） and time of extubation （ （ 12.9± 2.4） rain vs. （ 6. 8 ± 1.2 ） min, t = 12. 36, P = 0. 01 ） were significantly longer thanthat of propofol group （ P 〈 0. 05 ）. Conclusion Propofol combined with remifentanil TCI-based anesthesia could achieve the optimal hemdynamic stability during anesthesia maintance and better recovery profile from anesthesia in gynecological laparoscopic myomectomy.