瑞芬太尼复合丙泊酚TCI用于腹腔镜结肠癌根治术效果

Effects of target controlled infusion with remifentanil and propofol on laparoscopic resection of colon cancer

目的比较瑞芬太尼复合丙泊酚靶控输注（TCI）和芬太尼持续泵注复合丙泊酚靶控输注麻醉对腹腔镜结肠癌根治术患者的麻醉效果。方法行腹腔镜结肠癌根治术患者80例，ASAI一Ⅱ级。麻醉方法随机分为A组（40例）：靶控输注瑞芬太尼（血浆靶浓度3ng／ml）复合丙泊酚（血浆靶浓度3μg/m1）；B组（40例）：持续泵入芬太尼[3μg／（kg·h）]，靶控输注丙泊酚（血浆靶浓度3μg/ml）；比较两组患者麻醉前（T0）、诱导成功后（T1）、插管后（T2）、切皮时（T1）、停药时（T4）、睁眼时（T5）的心率（HR）、平均动脉压（MAP）、动脉血氧饱和度（SpO2）、脑电双频指数（BIS）、手术时间、恢复自主呼吸时间、睁眼时间、拔管时间及术后患者出现恶心、呕吐、躁动等不良反应情况。结果A组患者麻醉诱导成功后（T3）至停药时（T4）HR与麻醉前（To）相比明显减慢（P〈0．01），睁眼时（T5）HR较麻醉前明显增快（P〈0．01）；B组HR在麻醉过程中与麻醉前比较未见明显差异（P〉0．05），两组患者HR在T0～T4期间未见明显差异，T5时A组高于B组（P〈0．05）。所有患者T1～T4期间MAP、BIS比T0均明显下降（P〈0．01），SpO2未见明显改变（P〉0．05）。丽组患者在MAP、SpO2、BIS方面的差异无统计学意义（P〉0．05）。A组患者呼吸恢复时间、睁眼时间、拔管时间均早于B组，VAS评分A组高于B组（P〈0．01），而在手术时间及术后并发症方面未见明显差异（P〉0．05）。结论瑞芬太尼复合丙泊酚靶控输注在腹腔镜结肠癌根治术中能够维持稳定的血流动力，术后苏醒快，是腹腔镜结肠癌根治术安全可靠的麻醉方式。

Objective To make comparison of anesthetic effects between target controlled infusion （TCI） with remifentanil and propofol and continuous intravenous pumping with fentanyl plus TCI with propofol on patients receiving laparoscopic resection of colon cancer. Methods There were 80 patients receiving laparoscopic radical resection of colon cancer with the level of ASA I - ]]. According to the anesthetic methods, they were randomly divided into group A （40 cases） which received TCI with remifentanil （with the target level of 3 ng/ml） and propofol （with the target level of 3 μg/ml） and group B （40 cases） which received the continuous intravenous pumping with fentanyl [ 3μg/（ kg · h） ] and TCI with propofol （with the target level of 3 μg/ml）. Comparison was made in the heart rate （HR） before the anesthesia （T0）, at the successful induction （T1 ）, after the intubation （T2）, and at the time of skin incision, drug withdrawal, and eyes opening, the mean arterial pressure （ MVP）, arterial oxygen saturation （ SpO2 ）, bispectral index （BIS）, operative time, recovery time of spontaneous breathing, the time of eyes opening, extubation time, and postoperative complications such as nausea, vomiting, and restlessness between the two groups. Results In group A, the HR between T1 and T4 significantly slowed down compared with that at TO （ P 〈 0.01 ）, while the HR at Ts became significantly faster than that before the anesthesia （ P 〈0.01 ）. In group B ,there was no significant difference between the HR during and before the anesthesia （ P 〉 0.05 ）. There was no significant difference in the HR from To to T4 between the two groups. But at Ts , the HR of group A was higher than that of group B （P 〈 0.05 ）. The MAP and BIS between T1-T4 of all the patients significantly decreased compared with those at To （ P 〈 0.01 ）, but their SpO2 did not change （P 〉 0. 05）. There was no significant difference in MAP,SpO2, and BIS between the two groups （ P 〉0.05）. The recovery time of spontaneous breathing,the time of eyes opening,and the extubation time in group A were all shorter than those in group B, and the ASA score in group A were higher than that in group B （P 〈 0.01 ）. There was no significant difference in the operative time and postoperative complications （P 〉 0.05 ）. Conclusion In laparoscopic resection of colon cancer, TCI with remifentanil and propofol can maintain the stable hemodynamics. It achieves a faster analepsia and is a safe and reliable anesthetic method for laparoscopic resection of colon cancer.