两种静脉复合麻醉方法在腹腔镜手术中的应用效果比较

Contrast of two kinds of intravenous anesthesia method in laparoscopic surgery

目的 比较以右美托咪啶和丙泊酚为主的两种静脉复合麻醉方法在腹腔镜手术中的麻醉效果.方法 选择近年来六安市人民医院收治的腹腔镜手术患者120例,按不同的静脉麻醉方式分均为右美托咪啶组（A组,右美托咪啶＋芬太尼＋顺阿曲库铵）和丙泊酚组（B组,丙泊酚＋芬太尼＋顺阿曲库铵）,每组60例.分别观察两组患者在麻醉诱导、气管插管、建立气腹时的心血管反应,记录术中用药和术后恢复情况,并调查患者术中知晓发生率及满意度.结果 A组在麻醉诱导和气管插管阶段血压无明显变化,但建立气腹时血压升高,拔管后血压降低;B组麻醉诱导后血压降低.A组麻醉和手术过程心率降低,B组心率保持不变.B组清醒拔管时间均少于A组.A组阿托品和乌拉地尔的使用较多,麻黄碱使用较少.A组术后即时镇痛、恶心呕吐发生率少于B组（P均＜0.05）.结论 右美托咪啶、芬太尼、顺阿曲库铵静脉复合麻醉应用于腹腔镜手术的效果确切、安全,且无术中知晓发生.但术中需注意右美托咪啶诱导给药速度、加强心率、血压监护。

Objective To compare two intravenous anesthesia of right dexmedetomidine and propofol-based anesthesia in laparoscopic surgery.Methods One hundred and twenty cases of aparoscopic surgery patients were chose,according to different intravenous anesthesia,were randomly divided into right dexmedetomidine group （group A,right dexmedetomidine ＋ fentanyl ＋ cisatracurium,n =60） and propofol group （group B,propofol ＋ fentanyl ＋ cis atracurium,n =60）.Cardiovascular response of anesthesia induction,endotracheal intubation,establishment pneumoperitoneum about two groups patients was observed.Intraoperative medications and postoperative recovery was recorded,and the incidence of awareness surveys and satisfaction of patients was investigated.Results Blood pressure did not significantly chang in stage of induction anesthesia and endotracheal intubation of group A,but higher blood pressure when create pneumoperitoneum,lower blood pressure after extubation.Lower blood pressure after induction of anesthesia of group B.The heart rate reduced when anesthesia and surgical procedures in group A,but heart rate was constant in group B.The time to recovery from consciousness,time of exubation in group D were shorter than those in group A （P 〈 0.05）.More patients in group A were administered with atropine and urapidil but fewer patients used ephedrine compared with group B.Fewer patients in group A needed transient analgesics and fewer patients developed nausea and vomiting than those in group B （P 〈 0.05）.Conclusions Intravenous anesthesia with dexmedetomidine,fentanyl and cisatracurium is safe and reliable,and prevents awareness during anaesthesia.Noted intraoperative dose rate dexmedetomidine in surgery,strengthen the heart rate,blood pressure monitoring.