丙泊酚复合瑞芬太尼用于老年腹腔镜胆囊切除术的麻醉效果及对心血管应激的影响

Anesthesia effect of propofol combined with remifentanil on elderly patients undergoing laparoscopic cholecystectomy and its effect on cardiovascular stress

目的:探讨丙泊酚复合瑞芬太尼用于老年腹腔镜胆囊切除术的麻醉效果及对心血管应激的影响。方法:采用随机数字法,将120例行腹腔镜胆囊切除术老年胆囊良性病变患者分为对照组(n=60)与观察组(n=60)。对照组和观察组分别采取丙泊酚复合舒芬太尼、丙泊酚复合瑞芬太尼进行麻醉维持,比较两组麻醉效果及麻醉诱导前(T0时刻)、(麻醉诱导后)气管导管插管前(T1时刻)、气管插管后(T2时刻)、气管导管拔管后(T3时刻)、手术结束后(T4时刻)的心血管应激指标。结果:观察组自主呼吸恢复时间、苏醒时间、拔管时间及定向力恢复时间均少于对照组(P<0.05)。观察组T2、T3、T4时刻的血糖浓度、皮质醇、去甲肾上腺素水平均低于对照组(P<0.05)。观察组拔管后5 min、拔管后10 min的镇痛评分均高于对照组(P<0.05)。观察组术后不良反应发生率低于对照组(8.33%vs.21.67%,P<0.05)。结论:丙泊酚复合瑞芬太尼用于老年腹腔镜胆囊切除术的麻醉效果优于丙泊酚复合舒芬太尼,麻醉期间对心血管应激反应影响较小,不良反应发生率低,有利于患者的术后恢复。

Objective:To explore the anesthesia effect of propofol combined with remifentanil in laparoscopic cholecystectomy for the elderly and its effect on cardiovascular stress.Methods:120 elderly patients with benign gallbladder diseases undergoing laparoscopic cholecystectomy were divided into control group(n=60)and observation group(n=60).In the control group and the observation group,propofol combined with sufentanil and propofol combined with remifentanil were used for anesthesia maintenance.The anesthesia effect and cardiovascular stress indexes before anesthesia induction(T0 time),before tracheal intubation after anesthesia induction(T1 time),after tracheal intubation(T2 time),after extubation of tracheal tube(T3 time),and after operation(T4 time)were compared between the two groups.Results:The recovery time of spontaneous respiration,recovery time,extubation time and directional force in the observation group were shorter than those in the control group(P<0.05).The level of blood glucose,cortisol and noradrenaline at T2,T3 and T4 in the observation group were lower than those in the control group(P<0.05).The analgesic scores of the observation group 5 minutes after extubation and 10 minutes after extubation were higher than those of the control group(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group(8.33%vs.21.67%,P<0.05).Conclusion:Propofol combined with remifentanil is better than propofol combined with sufentanil in the elderly laparoscopic cholecystectomy.During the anesthesia period,it has less impact on cardiovascular stress response,and the incidence of adverse reactions is low,which is conducive to the postoperative recovery of patients.