高原地区腹腔镜胆囊切除术患者全身麻醉的临床分析研究

Clinical analysis of general anesthesia for laparoscopic cholecystectomy at high altitude

目的探讨甘孜州高原地区行腹腔镜胆囊切除术患者全身麻醉管理方法,评价应用价值。方法高原缺氧地区实施全身麻醉行腹腔镜胆囊切除手术70例患者,其中术中采用舒芬太尼间断滴定维持的患者33例为舒芬太尼组,术中采用瑞芬太尼持续静脉泵注维持的37例为瑞芬太尼组。比较两组围麻醉期的血压、心率、氧饱和度的波动变化,意识恢复和术毕拔管时间和苏醒延迟的发生率。结果瑞芬太尼组血压、心率、氧饱和度波动变化较舒芬太尼组小,意识恢复时间短,拔管时间缩短,术后低氧血症、苏醒延迟等并发症的发生率低,差异有统计学意义(P<0.05)。结论高原地区腹腔镜胆囊切除手术全身麻醉维持使用静脉泵注丙泊酚复合瑞芬太尼,围术期使用多模式镇痛,减少对高原缺氧地区患者机体的影响程度,可以提高围麻醉期的安全性。

Objective To explore the management method of general anesthesia for laparoscopic cholecystectomy in Ganzi plateau area.Methods Seventy patients with laparoscopic cholecystectomy were analyzed retrospectively.Of the 70 patients,33 patients receiving intermittent intraoperative sufentanil titration maintenance were assigned as sufentanil group,and 37 patients receiving continuous intraoperative intravenous pumping maintenance of remifentanil were assigned as remifentanil group.The incidence of blood pressure,heart rate,oxygen saturation,and delayed recovery in the patients during perianesthesia were analyzed.Results The intraoperative hemodynamic fluctuation of the remifentanil group was smaller than that of the sufentanil group,and the incidence of postoperative complications such as hypoxemia and delayed resuscitation was lower in the remifentanil group than that in the sufentanil group(P<0.05).Conclusion For intravenous infusion of sufentanil and remifentanil for general anesthesia maintenance in laparoscopic cholecystectomy in plateau area,combination of multi-mode analgesia in perioperative period can reduce the hypoxic influence in plateau area,and improve the safety during perioperative period.