瑞芬太尼复合丙泊酚用于老年高血压腹腔镜胆囊术的观察

Remifentanil combined with propofol for observation of hypertensive elderly laparoscopic cholecystectomy

目的探讨瑞芬太尼对腹腔镜胆囊手术老年高血压病人的影响。方法 40例全麻下拟行腹腔镜胆囊切除术的老年高血压患者随机分为瑞芬太尼组和芬太尼组,瑞芬太尼组术中维持用丙泊酚0.1-0.15 mg/（kg·min）和0.1-0.5μg/（kg·min）瑞芬太尼静脉微泵维持;芬太尼组以芬太尼0.05 mg静脉间断推注1-2次,丙泊酚0.15-0.3 mg/（kg·min）维持麻醉。记录两组患者平均动脉压（MAP）、心率（HR）、拔管时间及苏醒评分。结果两组气腹后、手术中、术后拔管时MAP、HR,瑞芬太尼组值明显低于芬太尼组,差异均有统计学意义（P〈0.05）。瑞芬太尼组的拔管时间为（9.40±0.99）min,较芬太尼组的（19.35±4.51）min短;30 min和60 min时间段苏醒评分为（5.60±0.50）、（5.80±0.41）分,较芬太尼组（4.35±＋0.48）、（5.15±0.36）分高,差异均有统计学意义（P〈0.05）。结论瑞芬太尼在老年高血压腹腔镜胆囊术能维持循环稳定,自主呼吸恢复快,苏醒迅速,减少应激反应。

Objective To explore the influence of remifentanil on laparoscopic gallbladder surgery in older patients with hypertension. Methods In 40 cases under general anesthesia undergoing laparoscopie eholecystectomyin elderly patients with hypertension were randomly divided into remifentanil group （group A） and fentanyl group （group B）, propofol 0.1 -0.15 mg/（kg, min） for maintenance and operation in group A and O. 1-0.5 μg/（kg· min） with remifentanil intravenous micro pump maintain,postoperative 30 min plus 0.05 mg fentanyl, B group with fentanyl 0.05 mg intravenous intermittent bolus 1-2, propofol 0.15-0.3 mg/（kg.min） maintenance of anesthesia. The MAP, HR, extubation time and wake rating of patients were recorded. Results After pneumoperitoneum,the values of MAP and HR in operation and postoperative extubation of the remifentanil group （group A） were significantly lower than those of the fentanyl group （group B） （P〈 0.05）. Group A has shorter extubation time and better recovery score than group B （P〈0.05）. Conclusion In laparoscopic surgery of old patients with hypertension, remifentanil can maintaincirculation stability, has faster recovery of spontaneous breathing, wakes quickly, and reduces the stress response.