雷米芬太尼联合丙泊酚对妇科腹腔镜手术患者的血流动力学及麻醉苏醒的影响

Influence of Hemodynamics and Anesthesia Emergence from Remifentanil Combined with Propofol Anesthesia in Patients Undergoing Gynecological Laparoscopy

目的:探讨雷米芬太尼联合丙泊酚对妇科腹腔镜手术患者的血流动力学及麻醉苏醒的影响。方法:将116例拟行妇科腹腔镜手术患者随机分为观察组和对照组,观察组给予雷米芬太尼联合丙泊酚全凭静脉麻醉,对照组给予芬太尼联合丙泊酚全凭静脉麻醉。比较两组术中平均动脉压(MAP)、心率(HR)、血气分析指标、患者麻醉后睁眼时间、拔管时间及答问切题时间。结果:麻醉诱导后两组平均动脉压(MAP)及心率(HR)均显著下降(P<0.05);观察组插管即刻及插管后2 min MAP及HR显著低于对照组(P<0.05);观察组麻醉后睁眼时间、拔管时间、答问切题时间显著早于对照组(P<0.05);与气腹前相比,气腹10 min、20 min及60min的PaCO2均升高(P<0.05),两组各时点其他血气分析指标比较无显著差别(P>0.05)。结论:妇科腹腔镜手术给予雷米芬太尼联合丙泊酚全凭静脉麻醉,可显著减轻插管应激心血管反应,保持血流动力学稳定,效果优于芬太尼联合丙泊酚麻醉。

Objective： To explore the anesthetic effect of remifentanil combined with propofol anesthesia in gynecological laparo- scopy. Methods： 116 cases scheduled for laparoscopic surgery were randomly divided into control group and experience group. Experien- ce group received total intravenous anesthesia of remifentanil-propofol. Control group were given fentanyl-propofol total intravenous anesthesia. The change of mean arterial pressure （MAP）, heart rate （HR） and blood gas analysis indexes during operation were compared in two groups. Duration of opening eyes on verbal command, extubation time and the recovery time of awareness were recorded. Results： Blood pressure and heart rate of two groups after anaesthetic induction greatly decreased （P〈0.05）; MAP and HR on endotracheal intubation instanter and 2 minutes after intubation in experience group were much lower than that in control group （P〈0.05）; Duration of opening eyes on verbal command, extubation time and the recovery time of awareness in experience group were much shorter than that in control group （P〈0.05）; Compared with before pneumoperitoneum, PaCOz greatly increased on 10 min, 20 min and 60 min after pneumoperitoneum （P〈0.05）; There were no significant difference of blood gas analysis indexes between two groups （P〉0.05）. Conclusion： Remifentanil combined with anesthesia for patients undergoing gynecological laparoscopy can greatly decrease intubation stress response and maintain hemodynamics stable. The effect of remifentanil combined with propofol anesthesia was superior to fentanyl-propofol in gynecological laparoscopy.