腹腔镜胆囊切除术不同麻醉方式选择的比较研究

Comparison of method choices in different anesthesia in laparoscopic cholecystectomy

目的比较气管内插管下全凭静脉麻醉与吸入七氟醚静吸复合麻醉在腹腔镜胆囊切除术中的麻醉应用效果及经济学分析。方法择期行腹腔镜胆囊切除术患者40例,随机分为两组,均使用丙泊酚、舒芬太尼、顺式阿曲库铵行麻醉诱导,Ⅰ组靶控输注(TCI)丙泊酚维持,Ⅱ组吸入七氟醚维持,术中按需追加舒芬太尼、顺式阿曲库铵维持镇痛与肌松。术中不同时点观察记录麻醉效果,术毕记录麻醉药品消耗量,比较分析两组的麻醉效果及经济学分析。结果两组患者麻醉时间、术中麻醉监控各指数均无统计学差异,麻醉术后并发症Ⅰ组显著低于Ⅱ组,而麻醉用药费用Ⅰ组显著高于Ⅱ组(502.4±81.2 vs.441.0±99.3元,P<0.05)。结论腹腔镜胆囊切除术中,全凭静脉TCI丙泊酚维持麻醉安全可控,有较少的麻醉并发症,但比吸入七氟醚静吸复合麻醉的麻醉用药费用更高。

Objective To compare the anesthesia drug costs in anesthesia endotracheal intubation total intravenous with sevoflurane inhalation anesthesia in laparoscopic cholecystectomy surgery .Methods Forty patients underwent laparoscopic cholecystectomy were randomly divided into two groups equally , with n=20 in each group.All patients were induced by propofol , sufentanil and cis-atracurium, group I received target controlled infusion ( TCI) of propofol to maintain , group II received sevoflurane to maintain .sufentanil and cis-atracurium was provided to maintain analgesia and muscle relaxation during the operation .Sedation depth was monitored by the anesthesia depth index (Narcotrend index, NI), and the NI was set in D grade.Anesthetic consumption and calculate drug costs was recorded and compared based on various narcotics unit .Results There was no significant difference in the patients demographic , anesthesia time and operation time .The drug cost was (502.4 ±81.2 Yuan, 5.9 ±1.0 Yuan/min) and (441.0 ±99.3 Yuan, 5.4 ±0.8 Yuan/min) in group I and group II, respectively.Group I was higher than group II ( P <0.05).Conclusions TCI propofol-based anesthesia was associated with higher costs than inhaled anesthetics sevoflurane .