高原与平原地区患者在腹腔镜胆囊手术中麻醉用药剂量的比较

Comparison of Anesthetic Drug Dosage between Patients in Highlands and Plain during Laparoscopic Cholecystectomy under General Anesthesia

目的比较高原与平原地区患者在腹腔镜胆囊切除术中全麻的麻醉用药量。方法选取行腹腔镜胆囊切除手术的100例患者为研究对象,其中高原地区患者50例(高原组),平原地区患者50例(平原组),ASAⅠ~Ⅱ级,肝、肾功能均正常。两组患者均插入喉罩并采用全凭静脉麻醉;术中进行麻醉深度监测,在复苏室对患者进行疼痛及术中知晓的评估,自诉疼痛则给予舒芬太尼镇痛,并根据患者需求使用镇痛泵,但镇痛泵药物使用量不纳入麻醉药物剂量统计。比较两组患者从麻醉开始到离开复苏室共计使用的麻醉药物用量、镇痛评分及复苏室追加药物情况。结果高原组患者麻醉过程中丙泊酚、舒芬太尼的用量明显小于平原组患者,差异有统计学意义(P<0.05);咪达唑仑、瑞芬太尼、苯磺顺阿曲库铵的用量及离开复苏室时患者镇痛评分比较,两组差异无统计学意义(P>0.05)。在复苏室再次给予舒芬太尼镇痛的患者中,高原组明显少于平原组,差异有统计学意义(P<0.05)。结论高原地区患者在全麻过程中舒芬太尼及丙泊酚的用量比平原地区患者明显减少。

Objective To compare the anesthetic does between the patients in the highlands and plain during laparoscopic cholecystectomy under general anesthesia.Methods A total of 100 patients in need of laparoscopic cholecystectomy with normal renal and hepatic functions,ASA I^II grade,were selected from Sichuan Academy of Medical Sciences Sichuan Provincial People′s Hospital and Aba Prefecture People′s Hospital and were divided into highland group（Group H,n=50）and plain group（Group P,n=50）.All the patients on general intravenous anesthesia were inserted with laryngeal mask.Monitoring of anesthetic depth was conducted during operation,and pain and intraoperative awareness were evaluated in postoperative room.Sufentanil was given to patients who felt pain and analgesia pump was used when asked by patients,the amount of which was not included in the statistics of anesthetic doses.The respective total amount of anesthetic does,sedation scores and additional drugs used in postoperative room in two groups were compared from the start of anaesthetizing till when leave the postoperative room.Results The amount of propofol and sufentanil used in Group H was significantly smaller than those used in Group P,the difference of which was statistically significant（P〈0.05）,while there was no statistically significant difference between the two groups in terms of the amount of midazolam,remifentanil,cisatracurium besilate used and sedation scores（P〉0.05）.The times of using additional sufentanil was markedly less frequent in Group H than in Group P.Conclusion The drug dosage of sufentanil and propofol when applying general anesthesia on the patients in the highlands were significantly smaller compared with their counterparts in the plain,the difference of which can be used to evaluate difference in anesthetic drug use on patients in different regions.