瑞芬太尼复合异丙酚靶控输注在中老年腹腔镜胆囊切除术麻醉中的应用效果

摘要

Objective To explore the application effect of remifentanil combined with propofol target controlled infusion in laparoscopic cholecystectomy of middle-aged and elderly patients. Methods 240 patients underwent elective laparo-scopic cholecystectomy from January 2011 to December 2014 in our hospital were selected and randomly divided into groupⅠand group II,120 cases in each group.The group Ⅰ was given remifentani combined with propofol target con-trolled infusion,the group II was given fentany and propofol.The level of systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR) and the index of hemodynamics in period of anesthesia induction,endotracheal intuba-tion and extubation in two groups was observed,The time of spontaneous breathing recovery,opening eyes time on call-ing,extubation time,orientation recovery time and the incidence rate of pain,nausea and vomiting in two groups was compared respectively. Results The level of SBP,DBP and HR in groupⅠ immediately after intubation was lower than that in groupII,with significant difference (P<0.01).The level of SBP,DBP in groupⅠ at 5 minutes after intubation and 5 minutes after operation was lower than that in group II,with significant difference (P<0.05).The time of spontaneous breathing recovery,opening eyes time on calling,extubation time,orientation recovery time after operation in groupⅠ was shorter than that in group II,with significant difference (P<0.05).There was no significant difference in the incidence rate of pain,nausea and vomiting between two groups (P>0.05). Conclusion The application effect of remifentanil com-bined with propofol target controlled infusion in laparoscopic cholecystectomy of middle-aged and elderly patients is significant,the induction of anesthesia and the hemodynamics is stable,the postoperative recovery is quick and the re-suscitation is complete.%目的：探讨瑞芬太尼复合异丙酚靶控输注在中老年腹腔镜胆囊切除术麻醉中的应用效果。方法选取本院2011年1月~2014年12月择期行腹腔镜胆囊切除术的240例患者作为研究对象，随机分为Ⅰ组和Ⅱ组，各120例。Ⅰ组采用瑞芬太尼和异丙酚行靶控输注，Ⅱ组采用芬太尼和异丙酚。观察两组麻醉诱导、气管插管及拔管期的收缩压(SBP)、舒张压(DBP)、心率(HR)及术中血流动力学指标水平，比较两组术毕停止输注后的自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间及疼痛、恶心、呕吐等不良反应发生率。结果Ⅰ组插管后即刻的SBP、DBP、HR水平显著低于Ⅱ组，差异有统计学意义(P<0.01)。Ⅰ组插管后5 min、手术后5 min的SBP、DBP水平显著低于Ⅱ组，差异有统计学意义(P<0.05)。Ⅰ组术后的自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间显著短于Ⅱ组，差异有统计学意义(P<0.05)。两组的头痛、恶心、呕吐发生率比较，差异无统计学意义(P>0.05)。结论瑞芬太尼复合异丙酚靶控输注在中老年腹腔镜胆囊切除术中的应用效果显著，麻醉诱导平稳，术中血流动力学稳定，术后恢复迅速，苏醒完全。