目的 比较丙泊酚、瑞芬太尼联合靶控输注麻醉,全凭吸入异氟醚及笑气麻醉,丙泊酚、笑气复合麻醉3种方法对腹腔镜胆囊切除术(LC)术中循环反应的影响.方法 将择期施行全麻下行腹腔镜胆囊切除术的患者90例随机分为Ⅰ组、Ⅱ组、Ⅲ组,每组30例.观察并记录入室静卧10 min(基础值T0),气腹0、5、10、15、20 min(T1~T5),放气即刻(T6)各时点平均动脉压(MAP)、心率(HR)的监测值,并观察术后恶心呕吐情况.结果 MAP:Ⅰ、Ⅱ组T2~T6时点MAP较T0明显增加(P<0.05);Ⅰ、Ⅱ组T2~T6时点MAP各时点明显比Ⅲ组高(P<0.05).HR:Ⅰ组HR在T2~T5时点较T0明显增加(P<0.05);Ⅱ组HR在T2~T6时点较T0明显增加(P<0.05);Ⅰ、Ⅱ组T2~T6的HR明显比Ⅲ组各时点高(P<0.05).恶心呕吐发生率:Ⅲ组术后恶心呕吐发生率明显少于Ⅰ组及Ⅱ组(P<0.05).结论 3种麻醉方法均不能完全抑制腹腔镜胆囊切除术建立气腹时的应激反应,但全凭静脉靶控输注丙泊酚复合瑞芬太尼麻醉方法可较好地控制手术及气腹时对呼吸及循环的影响,更能避免术后恶心呕吐的发生.%Objective To compare the effect of total intravenous anesthesia ( TIVA-propofol with remifen-tanil ), total inhalation anesthesia( TIA-isoflurane with nitrous oxide and O2) and general balanced anesthesia ( GBA-propofol , nitrous oxide and O2 ) on stress response in patients who underwent laparoscopic cholecystectomy. Methods 90 patients were randomized into three groups(Ⅰ, Ⅱ, Ⅲ) depending on whether they received TIVA,TIA or GBA. Mean arterial pressure and heart rate were monitored and recorded at every time point. Results For MAP, Group Ⅰ and Ⅱ increased more significantly at T2 ~ T6 than T0( P < 0. 05 ) and was significantly higher than that of group Ⅲ ( P <0. 05 ). For HR, there was no significant difference for each group at T0( P >0. 05 ); Group Ⅰ increased significantly at T2 ~ T5( P < 0. 05 ), Group Ⅱ increased significantly at T2 ~ T6( P < 0. 05 ), both Group Ⅰ and Group Ⅱ were significantly higher than that of group Ⅲ( P < 0. 05 ). Conclusion The three anesthetic methods can not completely inhibit the stress response during laparoscopic cholecystectomy, but TIVA can better control the surgery and pneumoper-itoneum affection to respiratory and circulatory, also can avoid the occurrence of postoperative nausea and vomiting.
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