不同剂量瑞芬太尼复合异丙酚靶控输注对腹腔镜手术患者血流动力学的影响

Influence of Different Dose of Remifentanil Combined with Propofol on Hemodynamics in Patients with Laparoscopic Operation by Target Controlled Infusion

目的探讨不同剂量瑞芬太尼复合异丙酚靶控输注对腹腔镜手术患者血流动力学的影响。方法选取医院收治的腹腔镜手术患者400例,按随机数字表法将其分为对照组和观察组,各200例。对照组患者给予6.0μg/L瑞芬太尼,观察组患者给予8.0μg/L瑞芬太尼,异丙酚血浆靶控浓度均为3.0μg/L。于麻醉前(T0)、切皮时(T1)、气腹后(T2)、气腹后30 min(T3)、气腹后1 h(T4)、气腹结束时(T5)比较两组患者的血流动力学指标。结果两组患者意识消失时间、麻醉时间、呼吸恢复时间、睁眼时间均无明显变化(P>0.05);与T0相比,T1~T5时两组脑电双频指数(BIS)均明显降低(P<0.05),观察组T1~T3时BIS明显低于对照组(P<0.05);观察组T1~T5时心率(HR)、平均动脉压(MAP)均明显低于对照组(P<0.05)。结论瑞芬太尼(8.0μg/L)复合异丙酚(3.0μg/L)靶控输注麻醉能明显抑制腹腔镜手术所致BIS,维持术中血流动力学的稳定性。

Objective To investigate the effect of different dose of remifentanil combined with propofol on hemodynamics in patients with laparoscopic operation by target controlled infusion( TCI). Methods 400 patients with laparoscopic operation in our hospital were divided into the control group and the observation group according to the random number method,200 cases in each group. The control group was given 6. 0 μg / L remifentanil,and the observation group was given 8. 0 μg / L remifentanil,and the target plasma control dose of propofol was 3. 0 μg / L in the two groups. The changes of hemodynamics in two groups were observed and compared on before anesthesia( T0),skin incision( T1),after penumoperitoneum( T2),30 min after penumoperitoneum( T3),1 h after penumoperitoneum( T4),end of penumoperitoneum( T5). Results The times of consciousness disappearance,anesthesia,breathing recovery and eye opening had no significant changes in the two groups( P > 0. 05); compared with T0,the bispectral index( BIS) on T1- T5 were significantly decreased in two groups( P < 0. 05); compared with the control group,the BIS on T1- T3 were significantly decreased in the observation group( P < 0. 05),the hear rate( HR) and mean arterial pressure( MAP) on T1- T5 were significantly decreased in the observation group( P < 0. 05). Conclusion The TCI of remifentanil( 8. 0 μg / L) combined with propofol can significantly inhibit the BIS induced by laparoscopic operation,and maintain the stability of hemodynamics during the laparoscopic operation.