瑞芬太尼、丙泊酚全凭静脉麻醉与静吸复合麻醉用于腹腔镜胆囊切除术的比较

Comparison between Remifentanil,Propofol total intravenous anesthesia and inhalation combined anesthesia in laparoscopic cholecystectomy

目的对比瑞芬太尼、丙泊酚全凭静脉麻醉与静吸复合麻醉应用于腹腔镜胆囊切除术(LC)的临床疗效。方法将68例择期行LC患者随机分为对照组(静吸复合麻醉组)和观察组(全凭静脉麻醉组),各34例。对照组以丙泊酚、芬太尼、咪唑安定、氯化琥珀胆碱诱导后气管插管,术中以异氟醚作麻醉维持;观察组以瑞芬太尼代替芬太尼诱导,以瑞芬太尼、丙泊酚作麻醉维持,其余用药同对照组。比较两组患者入室后、诱导后、插管后、切皮前、术毕各时间点心率、血压变化及术后自主呼吸恢复时间、睁眼时间、拔管时间。结果观察组患者诱导后心率低于对照组、术毕心率高于对照组,诱导后、插管后收缩压均低于对照组(P<0.01);其余各时间点两组患者心率、血压比较,均无统计学差异(P>0.05)。观察组患者自主呼吸恢复时间、睁眼时间及拔管时间均较对照组明显缩短(P<0.05)。结论与静吸复合麻醉下行LC比较,瑞芬太尼、丙泊酚全凭静脉麻醉术前诱导更平稳,术后患者苏醒迅速,安全有效。

Objective To compare the clinical curative effects of Propofol, Remifentanil total intravenous anesthesia and inha- lation in laparoscopic cholecystectomy（LC）. Methods Sixty-eight patients who were going to receive LC surgery were randomly divid- ed into the control group in which the patients would receive inhalation combined anesthesia and the observation group in which the pa- tients would receive total intravenous anesthesia. The patients in the control group received the endotracheal intubation after the induc- tion by Propofol, Fentanyl, Suceinylcholine chloride and were maintained with Isoflurane anesthesia during operation while the patients in the observation group were induced with Remifentanil instead of Fentanyl and Maintained with Remifentani｜ and Nepal Propofol. The rest medication was equivalent to the patients in the control group. The blood pressure, heart rate recovery time, postoperative sponta- neous breathing, eye opening time and extubation time of all the patients after induction, intubation and incision were compared. Results The heart rate of the patients in the observation group after induction was lower than that of the patients in the control group, while postoperative heart rate was higher than that of the patients in the control group, systolic blood pressure after induction and intubation was lower than that of the patients in the control group （ P 〈 0.01 ）. Heart rate and blood pressure of the patients in both groups had no statistical differences （ P 〉 0.05）. The spontaneous breathing recovery time, eye opening time and extubation time of the patients in the observation group were significantly shorter than those of the patients in the control group （ P 〈 O. 05）. Conclusion Compared with inhalation combined anesthesia, Propofol, Remifentanil total intravenous anesthesia in LC which is a safe and effective anesthesia method can induce more smoothly and make postoperative patients wake up more quickly.