靶控输注异丙酚复合瑞芬太尼在老年人腹腔镜胆囊切除术中的应用

摘要

目的 探讨异丙酚复合瑞芬太尼靶控输注(Target-controlled infusion, TCI) 全凭静脉麻醉用于老年人腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)的可行性及安全性.方法 择期LC手术老年患者56例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级I-Ⅱ级,心肺功能正常. 随机等分为静吸麻醉组(I组)和静脉全麻组(T组),两组均以咪选唑仑、异丙酚、芬太尼、雏库溴铵诱导后做气管插管.麻醉维持:静吸麻醉组(I组, n=28例)采用3%异氟醚吸入诱导,1%～2.5%维持,间断辅以瑞芬太尼静注;全凭静脉组(T组, n=28例)将瑞芬太尼和异丙酚混合液持续恒速输入, 诱导时设定瑞芬太尼血浆靶浓度为4～8ng/ml,异丙酚为3～5μg/ml,术中根据血压、心率调整靶浓度. 术中监测心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)等指标及手术结束至自主呼吸、睁眼、拔除气管导管、恢复定向能力的时间等.结果 两组间的拔管时间、清醒程度有显著差异.静吸麻醉组(I组)在气腹后10 min的HR、SBP、DBP及术毕明显高于术前基础值(P＜0.05或P＜0.01),而全凭静脉组术中无明显变化,术后恶心呕吐发生率也明显低于静吸组.结论 异丙酚复合瑞芬太尼靶控输注静脉麻醉用于老年人腹腔镜胆囊切除术可达满意的麻醉深度,具有苏醒快,围术期血压、心率变化幅度小,能降低术后恶心呕吐的发生, 患者安全系数高等优点, 且无吸入麻醉药的手术室空气污染, 优于异氟醚吸入麻醉方法 .%Objective To investigate the feasibility and security of target-controlled infusion with remifentanil and propofol to the elderly laparoscopic cholecystectomy. Methods Fifty-six elderly patients undergoing selected LC,grade I-II of American Society of Anesthesiologjsts (ASA),with normal cardiac and lung function, were randomly divided into 2 groups of 28 patients each:inhalation anesthesia group (I-group) and intravenous anesthesia group(T-group).Following induction with midazolam, propofol, remifentanil and vecuronium,anaesthesia was maintained with remifentanil/ isoflurane in I-group or remifentanil/propofol in T-group.I-group was induced by by 3% isoflurane inhalation and maintained with 1%～2.5%. The target plasma concentration of remifentanil was 4-8ng/ml and propofol was 3-5ug/ml in T-group. The concentration was adjusted with blood pressure and heart rate. HR(heart rate), SBP(systolic blood pressure), DBP (diastolic blood pressure), MAP(mean arterial pressure) were monitored continuously in two groups during operation.The interval time from the end of operation to spontaneous respiration,eyes-opening, extubation and orientation were recorded. Results In the two groups, there were significant difference in extubation time and awake extent. The HR、SBP、DBP of pneumoperitoneum after 10 min and after surgery were much higher than that of preoperation, while there was no obvious change in T-group. The induction time and incidence of nausea and vomiting after surgery were also much less in T-group than I-group. The vital signs were stable in T-group during operation.The patients in T-group gained more comfortable recovery than those in I-group.Conclusions Target-controlled infusion with remifentanil and propofol to the elderly laparoscopic cholecystectomy can get satisfied depth of anesthesia and better recovery. So the anaesthesia maintained by propofol target controlled infusion for lapamscopic choleeystectomy is better than that by isoglurane inhalation.