异丙酚、芬太尼全凭静脉麻醉用于腹腔镜胆囊切除术

A Clinical Study of Total Intravenous Anesthesia With Propofol and Fentanyl in Laparoscopic Cholecystectomy

目的 :研究异丙酚和芬太尼全凭静脉麻醉在腹腔镜胆囊切除术 (LC)的应用及其效果评价。方法 :择期LC手术的患者 80例 ,随机等分为静吸复合麻醉组 (静吸组 )和全凭静脉麻醉组 (全静脉组 )。两组均以咪唑安定 0 .2mg·kg-1 、异丙酚 2mg·kg-1 和维库溴铵 0 .1mg·kg-1 诱导后作气管插管。麻醉维持 :静吸组用安氟醚吸入 ,全静脉组将异丙酚 8mg·kg-1 ·h-1 和芬太尼 4 μg·kg-1 ·h-1 混合抽入 5 0ml注射器中 ,用微量泵注入 ,设定速率为 4 0ml·h-1 。记录麻醉诱导前、气腹前和气腹后 1 0min、气腹毕和术毕的SBP、DBP、HR和SpO2 及停止麻醉至拔管的时间、拔管时的清醒程度和随访结果。结果 :两组间的拔管时间、清醒程度无显著性差异。静吸组在气腹后 1 0min的HR、SBP、DBP及术毕HR明显高于基础值 (P <0 .0 5 ) ,而全静脉组术中无明显变化。全静脉组的术后恶心呕吐发生率明显低于静吸组。结论 :异丙酚和芬太尼全凭静脉麻醉用于LC手术 ,具有麻醉效果满意、血液动力学稳定、苏醒快速、术后恶心呕吐率低。

Objective: To study the application of total intravenous anesthesia (TIVA) with propofol and fentanyl to larparoscopic cholecystectomy (LC) and to assess its usefulness in clinical practice. Methods: 80 cases of LC were randomly and evenly assigned to two groups: the combined intravenous with inhalation anesthesia (CIIA) group and the TIVA group. Midazolam 0.2 mg·kg -1 ,propofol 2 mg·kg -1 and vecurium 0.1 mg·kg -1 were injected intravenously for induction in both groups. Enfluane was inhaled in CIIA and the mixture of fentanyl 40 μg·kg -1 and propofol 4 mg·kg -1 was infused with an infusion pump at 40 ml·h -1 (propofol 8 mg·kg -1 ·h -1 and fentanyl 4 μg·kg -1 ·h -1 )in TIVA to maintain anesthesia. BP, HR and SpO 2 at all stages and time for extubation,the consciousness and follow up results were recorded. Results: There were no significant differences in extubation and operation time, the recovery degree of consciousness and follow up results between two groups (P>0.05). HR, SBP, DBP at 10 min following inflation and HR at the end of operation in CIIA group were significantly higher than their basic values (P<0.05) whereas no significant changes occurred in TIVA group. Additionally, the incidence of vomiting and emesis was significantly lower in TIVA group than that in CIIA group. Conclusion: The application of TIVA with propofol and fentanyl to LC is characterized with stable hemodynamics and no pollution to the operating room, and worthy of widespread application in clinical practice.