目的：研究七氟醚联合瑞芬太尼麻醉对老年患者腹腔镜胆囊手术应激反应及血流动力学的影响，为老年患者腹腔镜手术提供一种合理的麻醉方法。方法60例择期行腹腔镜胆囊手术的老年患者随机分成七氟醚组（Q 组）和丙泊酚组（B 组），七氟醚组诱导使用8％七氟醚半紧闭吸入，麻醉维持用七氟醚吸入和瑞芬太尼泵注；丙泊酚组患者静注依托咪酯0.3mg/kg，麻醉维持用丙泊酚和瑞芬太尼静脉泵注。分析比较两组患者不同时间点血糖、皮质醇和血流动力学的变化。结果七氟醚组血流动力学明显比丙泊酚组平稳，皮质醇和血糖各时间点无明显改变（P ＞0.05）；丙泊酚组 T2、T3、T4、T5时皮质醇、血糖明显升高，与七氟醚组同时间点比较，差异有统计学意义（P ＜0.05）。结论七氟醚联合瑞芬太尼麻醉应激反应小，血流动力学平稳，适于老年患者腹腔镜手术麻醉。%Objective To research the effects of sevoflurane combined remifentanil anesthesia on stress response and hemodynamics of laparoscopic gallbladder operation in gerontal patients, to provide a reasonable anesthesia method for laparoscopic gallbladder operation in gerontal patients. Methods A total of 60 patients scheduled for laparoscopic gallbladder operation were randomly divided into two groups: sevoflurane group(Group Q)and propofol group(Group B).Group Q was inducted with sevoflurane(8%) and maintained with sevoflurane inhalation and remifentanil pump infusion; while the Group B was inducted with etomidate (0.3mg/kg) and maintained with propofol and remifentanil pump infusion. The plasma concentration of blood sugar, cortisol and variations of haemodynamics at the different time were measured. Results Group Q has more stabile haemodynamics than Group B( > 0.05), but the concentrations of cortisol and blood sugar had no significant changes at the every time points; The concentrations of cortisol and blood sugar were significantly increased at T2、T3、T4、T5 time points in Group B, and also significantly higher than those in the Group Q(P < 0.05). Conclusion Because of depressing stress reaction and stabile haemodynamics, sevoflurane inhalation combined with remifentanil pump infusion anesthesia is one of the reasonable anesthesia methods for laparoscopic gallbladder operation in gerontal patients.
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