维拉帕米应用于腹腔镜下全子宫切除术麻醉中的临床观察

Clinical observation of applying Verapamil to anesthesia of patients accepting total laparoscopic hysterectomy

目的观察脑电双频指数(BIS)监测下腹腔镜下全子宫切除术患者麻醉中使用维拉帕米对麻醉深度的影响。方法选择美国麻醉师协会分级(ASA)Ⅰ～Ⅱ级、静脉全麻择期腹腔镜下全子宫切除手术患者80例,将其随机分为两组,各40例。治疗组常规诱导及建立气腹时予以维拉帕米5 mg静脉缓慢滴注;对照组则予以常规诱导,两组术中均给予丙泊酚、瑞芬太尼静脉持续泵入维持麻醉。维持BIS值40～50,并监测患者血压及心率变化。结果麻醉期间治疗组丙泊酚、瑞芬太尼的使用量显著低于对照组(P<0.05);治疗组苏醒时间显著短于对照组(P<0.05),治疗组术中血压、心率控制较对照组平稳。拔管后患者躁动例数无明显差异(P>0.05),两组患者术后均未发生术中知晓。术后24 h视觉模拟评分(VAS)治疗组低于对照组(P<0.05)。结论腹腔镜下子宫切除术麻醉中应用维拉帕米能降低患者静脉麻醉药用量,稳定术中循环,减少伤害性刺激。

Objective To observe the effect of Verapamil applying to patients accepting total laparoscopic hysterectomy under intravenous general anaesthesia.Methods 80 patients accepting total laparoscopic hysterectomy under intravenous general anaesthesia with ASA Ⅰ-Ⅱ were chosen and assigned randomly into two groups,with 40 cases in each group.The patients of treatment group were administered by intravenous drip of Verapamil 5 mg at the time of established pneumoperitoneum and the patients of control group were not administered by Verapamil.Routine anesthesia induction was applied to all patients.Propofol and Remifentanil were used to maintain anesthesia.Bispectral index were controlled from 40 to 50.The changes of blood pressure and heart rate were monitored.Results In treatment group,the dose of Propofol and Remifentanil was significantly less than that in control group（P〈0.05）.Recovery time of treatment group was less than control group（P〈0.05）.The blood pressure and heart rate of treatment group were more stable than control group.There was no significant difference of restless cases after drawing tube（P〈0.05）,both groups had no intraoperative awareness.The score of 24 h VAS in treatment group was less than control group（P〈0.05）.Conclusion Verapamil can reduce the dose of Propofol and Remifentanil during intravenous general anaesthesia for total laparoscopic hysterectomy and stabilize circulatory system.