异丙酚联合瑞芬太尼对腹腔镜胆囊切除术患者麻醉效果及CBF、GMR的影响

Effect of propofol combined with remifentanil on anesthesia and CBF,GMR in patients undergoing laparoscopic cholecystectomy

目的探讨异丙酚联合瑞芬太尼对腹腔镜胆囊切除术患者脑血流量(CBF)、葡萄糖代谢率(GMR)的影响及麻醉效果,为腹腔镜胆囊切除术患者麻醉方式的选择提供参考。方法选择我院2017年5月～2018年5月收治的拟行腹腔镜胆囊切除术的160例患者作为研究对象,按照麻醉方式不同分为观察组和对照组,各80例,其中对照组给予七氟醚麻醉,观察组给予异丙酚联合瑞芬太尼复合麻醉,观察两组患者的麻醉诱导及恢复情况。结果观察组患者的诱导时间、拔管时间、睁眼时间及PACU停留时间明显短于对照组;拔管后30 min、拔管后60 min,观察组患者的OAA/S评分明显高于对照组;T2和T3时,观察组患者的CBFV和PI值明显低于对照组,差异具有统计学意义(P<0.05)。与清醒时相比,两组患者意识消失后不同脑区的GMR均明显降低,差异具有统计学意义(P<0.05)。结论异丙酚联合瑞芬太尼对腹腔镜胆囊切除术患者进行麻醉,可以减少其麻醉诱导时间、拔管时间、睁眼时间以及PACU停留时间,改善CBF和GMR,具有较好麻醉效果,值得临床推广使用。

Objective To investigate the effect of propofol combined with remifentanil on cerebral blood flow(CBF)and glucose metabolic rate(GMR)and its anesthesia effect in patients undergoing laparoscopic cholecystectomy,which provides a reference for the choice of anesthesia for patients undergoing laparoscopic cholecystectomy.Methods A total of 160 patients planning to undergo laparoscopic cholecystectomy from May 2017 to May 2018 were enrolled in the study.They were divided into observation group and control group according to different anesthesia methods,with 80 cases in each group.The control group was given sevoflurane anesthesia.The observation group was given propofol combined with remifentanil for anesthesia.The anesthesia induction and recovery of the two groups were observed.Results The induction time,extubation time,blink time and PACU stay time of the observation group was significantly shorter than that of the control group.The OAA/S score of the observation group was significantly higher than that of the control group at 30 min and 60 min after extubation.At T2 and T3,the CBFV and PI values of the observation group were significantly lower than those of the control group,and the difference was statistically significant(P<0.05).Compared with that of awaking time,the GMR of different brain regions decreased significantly after the disappearance of consciousness in both groups,and the difference was statistically significant(P<0.05).Conclusion Propofol combined with remifentanil for anesthesia in patients undergoing laparoscopic cholecystectomy can reduce anesthesia induction time,extubation time,blink time and PACU residence time,improve CBF and GMR,which has good anesthetic effect.It is worthy of clinical promotion.