瑞芬太尼靶控静脉麻醉用于妇科腹腔镜手术的临床观察

目的 比较不同靶控浓度瑞芬太尼复合丙泊酚全凭静脉麻醉与传统的静吸复合麻醉对机体应激反应的影响和血流动力学变化.方法 ASAⅠ～Ⅱ级妇科腹腔镜手术患者45例,随机分为静吸复合麻醉组(Ⅰ组),不同靶控浓度(4、6ng/ml)瑞芬太尼全凭静脉麻醉组(Ⅱ、Ⅲ组).每组15例.观察和测定麻醉前(T1),插管后1 min(T2),气腹后20 min(T3),气腹结束后20 min(T4)时的血压、心率、血糖和皮质醇.观察术毕停药后患者呼之睁眼时间、拔管时间,观察恶心呕吐等副反应,记录术中知晓的发生率和患者满意度等.结果 ①Ⅲ组皮质醇含量在T3、T4时点与Ⅰ组比较明显下降(P<0.01).②Ⅲ组血糖在T4时点同麻醉前比较升高(P<0.05),但同Ⅰ组比较差异有统计学意义(P<0.05).③Ⅲ组HR在T2、T3时点同Ⅰ组比较明显下降(P<0.01),Ⅲ组MAP在T2时点同Ⅰ组比较下降(P<0.05).④Ⅱ、Ⅲ组睁眼时间及拔管时间同Ⅰ组比较缩短(P<0.05).结论 在妇科腹腔镜手术中,丙泊酚3 μg/ml靶控瑞芬太尼6ng/ml全凭静脉麻醉比传统的静吸复合麻醉能更有效地抑制二氧化碳气腹所致的应激反应,苏醒快,且能获得血流动力学的稳定性.

Observation of target plasma concentration of remifentanil total intravenous anesthesia in gynecological laparoscopic surgery

Objective To compare the effects of different target plasma concentration of remifentanil total intravenous anesthesia and intravenous-inhaled anes-thesia.Methods Forty-five ASAⅠ～Ⅱ patients undergoing gynecological laparoscopy were randomly divided into three groups,fentanyl combined propfol and sevoflurane(Ⅰ),the target plasma concentration of remi-fentanil wasset at 4,6ng/ml separately(Ⅱ,Ⅲ).Recorded the changes of MAP,HR and blood glucose and cortisol before anesthesia(T1),one minute after tracheal intubation(T2),20 minutes after peneumoperitoneum(T3) and 20 minutes after insufflation was given off(T4),the time of eye opening and tracheal extubating,the extent of pain and complications of nauseaand vomiting.Results The plasma level of cortisol in group Ⅲ at T3 and T4were significantly lower than those in group Ⅰand Ⅱ(P<0.01).Blood suger of groupⅠ、Ⅱ and Ⅲ at T4were little higher than those before anesthesia,but it had significant difference in group Ⅰ and Ⅱ(P<0.05).Mean arterial blood pressure of group Ⅱ and Ⅲ at T2 be lower than groupⅠ(P<0.05),Heart rate of group Ⅱ and Ⅲ at T2 and T3be lower than groupⅠ(P<0.01).Eye opening as requesting and tracheal extubating of group Ⅱ and Ⅲ be shorter than groupⅠ.Conclusion In the gynecological laparoscopic surgery TCI of remifentanil 6 ng/ml and propofol 3 μg /ml can relieve the stress response to carbon dioxide peneumoperitoneum,achieve the stability of the hemodynamic and the better recovery after operation.