腹腔镜胆囊切除术给予靶控输注丙泊酚加以雷米芬太尼的麻醉效果观察

Anesthetic Effect of Target-Controlled Infusion with Propofol and Remifentanil During Laparoscopic Cholecystectomy

目的探讨腹腔镜胆囊切除术给予靶控输注丙泊酚加以雷米芬太尼的麻醉效果与安全性。方法选取我院收治的106例行腹腔镜胆囊切除术的患者为研究对象,随机分为对照组(n=53)和实验组(n=53),两组前期处理与麻醉诱导方案相同,对照组在此基础上应用静脉复合吸入麻醉,实验组则在麻醉诱导完成后应用丙泊酚加以雷米芬太尼靶控输注维持麻醉,观察比较两组患者不同时间点生命体征指标的差异,统计两组术后恢复自主呼吸时间、苏醒时间、拔管时间以及不良反应等。结果实验组患者不同时间点的HR、SBP、DBP与Sa O2均未见明显变化(P>0.05),对照组的T1(首次腹部穿刺)、T2(建立CO2气腹10min后)、T3(术毕拔管即刻)的HR、SBP、DBP与T0(麻醉诱导前)相比有明显改变(P<0.05),与实验组相比亦有明显差异(P<0.05)。实验组患者的术后恢复自主呼吸时间、苏醒时间以及拔管时间均显著短于对照组(P<0.05)。实验组术后不良反应发生率为5.7%,显著低于对照组的22.6%(P<0.05)。结论腹腔镜胆囊切除术中给予丙泊酚加以雷米芬太尼靶控输注有助于稳定术中生命体征,加快术后恢复,且术后不良反应少,是较为理想的麻醉方式,值得临床重视并予以推广。

Objective To explore the anesthetic effect and safety of target-controlled infusion with propofol and remifentanil during laparoscopic cholecystectomy. Methods A total of 106 cases of patients with laparoscopic cholecystectomy in our hospital were selected and randomly divided into two groups, with 53 cases in each group. Both groups received same former treatment and anesthesia induction program; in addition, the control group was given intravenous anesthesia combined with inhalation anesthesia, while the experimental group was given target-controlled infusion with propofol and remifentanil for maintenance of anesthesia. The indicators of vital signs at different time points of two groups were observed and compared, and the postoperative recovery time of spontaneous respiration, awakening time, extubation time and adverse reactions were recorded. Results The HR, SBP, DBP and SaO2 of experimental group at different time points had no statistical difference （P〉0.05）, while the HR, SBP and DBP at T1 （first abdominal puncture）, T2 （10 min after establishment of CO2 pneumoperitoneum） and T3 （extubation） of control group were statistically different from those at To （before induction of anesthesia） of control group, and those at TI, T2 and T3 of experimental group （P 〈0.05）. The postoperative recovery time of spontaneous respiration, awakening time and extubation time were significantly shorter than those of control group （P〈0.05）. The incidence of postoperative adverse reactions of experimental group was 5.7%, significantly lower than 22.6% of control group （P 〈0.05）. Conclusions Target-controlled infusion with propofol and remifentanil during laparoscopic cholecystectomy helps to stabilize vital signs during operation and accelerate postoperative recovery with fewer postoperative adverse reactions, which is an ideal anesthesia method, and deserves clinical promotion.