丙泊酚靶控输注复合地氟烷吸入麻醉用于老年妇科腹腔镜手术患者的效果

Effects of propofol target-controlled infusion and inhalation desflurane during gynecological laparoscopic operation in the elderly

目的观察丙泊酚靶控输注(T_CI)复合地氟烷吸入麻醉维持用于老年妇科腹腔镜手术患者的效果。方法将90例择期行老年妇科腹腔镜手术的患者随机分为P组:丙泊酚T_CI,PD组:丙泊酚T_CI复合地氟烷吸入和D组:地氟烷吸入,每组30例。麻醉诱导后插管行机械通气。麻醉维持:P组丙泊酚血浆靶浓度3-4μg/ml,PD组在P组的基础上复合吸入地氟烷2%-3%,D组吸入地氟烷5%-8%。记录各组在入室时(T_0)、气管插管即刻(T_1)、气管插管后5min(T_2)、二氧化碳气腹建立即刻(T_3)、气腹建立后5min(T_4)、气腹建立后15min(T_5)、气腹建立后25min(T_6)、气管拔管即刻(T_7)、气管拔管后5min(T_8)各时间点的血流动力学参数;记录自主呼吸恢复时间、听指令睁眼时间、拔管时间、苏醒室(PACU)停留时间、手术时间、术中出血量、术后恶心呕吐(PONV)例数和躁动例数。结果 PD组在T_3、T_4、T_5时的MAP和在T_3时的HR比P组更低(P<0.05);PD组在听指令睁眼时间和拔管时间短于P组(P<0.05);P组和PD组早期(PACU内)恶心呕吐发生率(3.33%)明显低于D组(26.67%)(P<0.05),但三组在病房PONV发生率和躁动方面无明显差异(P>0.05)。结论三种麻醉均可安全用于老年妇科腹腔镜手术,丙泊酚T_CI复合地氟烷吸入的麻醉维持方法,术中血流动力学更稳定,术后早期恢复更快且恶心呕吐发生率低。

ObjectiveTo observe the effects of anesthesia maintenance combined propofol target-controlled infusion（TCI）with inhalation desflurane during gynecological laparoscopic operation in the elderly.Methods 90 patients scheduled for gynecological laparoscopic surgery were randomly allocated into three groups of 30 each.In the propofol maintenance group（Group P）,the target plasma propofol concentration was set at 3-4μg/ml.In the propofol combined with desflurane maintenance group（Group PD）,patients received desflurane at end-tidal concentration of 2%-3% on the basis of Group P.In the desflurane maintenance group（Group D）,the end-tidal concentration of desflurane was set at5%-8%.Following indexes were recorded：haemodynamics at each time point of pre-intubation（T0）,spontaneous intubation（T1）,5min intubation（T2）,spontaneous CO2insufflation（T3）,5-25 min post-CO2insufflation（T4-T6）,removing endotracheal tube（T7）,5min post-extubation（T8）;the time of returning to spontaneous ventilation,eye opening,tracheal extubation,staying in PACU;peri-operative bleeding,operation time,postoperative nausea and vomiting（PONV）,emergence agitation（EA）.Results The MAP at T3,T4,T5 and the HR at T3 in Group PD were lower than those in Group P（P〈0.05）.The time of eye opening and tracheal extubation in Group PD was also less than Group P（P〈0.05）.The early incidence of PONV in Group D（26.67%）was significant higher than those in Group PD and Group P（3.33%）（P〈0.05）.While there were no differences about the incidences of PONV in ward and emergence agitation among three groups（P〉0.05）.Conclusion It can be safely in gynecological laparoscopic operation in the elderly with three anesthetic methods,and the anesthesia maintenance of combining propofol TCI with inhalation desflurane was beneficial for stable haemodynamics,early postoperative recovery and the low incidence of PONV.