全凭静脉麻醉在腹腔镜手术中的应用被引量：11

Application of total intravenous anaesthesia in laparoscopic operation

导出

摘要目的评价丙泊酚靶控输注复合瑞芬太尼微量泵持续输注全凭静脉麻醉术中血流动力学变化和术后苏醒过程。方法ASAⅠ、Ⅱ级择期腹腔镜手术患者30例,随机分为两组。两组均以咪唑安定0.05mg/kg、维库溴铵0.1mg/kg、丙泊酚1.5mg/kg、瑞芬太尼1.5μg/kg诱导后气管插管。麻醉维持:全凭静脉麻醉组(A组,n=15)采用丙泊酚靶控输注,设定靶浓度2～2.5μg/ml;静吸复合麻醉组(B组,n=15)吸入异氟烷,维持呼气末浓度为0.6%～0.7%;瑞芬太尼两组输注方法相同,微量泵持续注入0.25μg/(kg·min)。所有药物术毕停用。记录诱导前、CO2气腹前、CO2气腹后10min、CO2气腹后30min、苏醒期血压、心率。观察术毕停药后患者自主呼吸恢复时间、呼之睁眼时间、拔管时间,术后恶心、呕吐和术中知晓发生率。结果①A组CO2气腹前后比较及苏醒期与诱导前比较,血压、心率无显著性变化;B组气腹后10minSBP、DBP较气腹前有显著升高(P<0.05),苏醒期血压、心率较诱导前有显著升高(P<0.01)。②两组自主呼吸恢复时间、呼之睁眼时间比较差异无显著性,拔管时间A组显著快于B组(P<0.05)。③术后恶心、呕吐发生率比较差异无显著性,两组均无术中知晓。结论与静吸复合比较,丙泊酚与瑞芬太尼联合输注全凭静脉麻醉血流动力学更稳定、苏醒迅速、苏醒质量更高。 Objective To evaluate the recovery and hemodynamics of total intravenous anaesthesia（TIVA） with propofol and remifentanil. Methods 30 ASA Ⅰ - Ⅱ patients undergoing laparoscopic operation were randomly divided into two groups（ n = 15 for each）：the TIVA group（ group A） and the combined intravenous with inhalation anaesthesia group（ group B）, Anaesthesia was induced in the same manner in both groups ： Midazolam 0.05mg/kg, vecurium 0. 1mg/kg, propofol 1.5mg/kg and remifentanil 1.5 μg/kg. Remifentanil was infused with an infusion pump at 0.25 μg/kg/min and it was combined with a propofol infusion under TCI （ 2-2.5 μg/ml ） in group A or with isoflurane（0.6%-0.7% end-tidal） in group B to maintain anaesthesia. With termination of surgery, anaesthetic delivery was discontinued simultaneously. Bp and HR at all stages and recovery profiles were recorded. Result ①Between before inflation and after inflation or between at the end of operation and the basic values in group A, there were no significant differences in BP and HR in group A,but after 10 minutes of inflation SBP and DBP were significantly increased in group B （ P 〈 0.05 ） , and BP and HR were higher during consciousness than before induction （ P 〈 0.01 ）. ② Times from stopping administration of anaesthetics until full spontaneous respiration and eye opening were similar for two groups. Time for trachcal extubation was significantly less in the group A than group B （ P 〈 0.05 ）. ③The rates of postoperative nausea or vomiting were similar. Conclusion The application of TIVA with propofol and remifentanil is associated with better hemodynamic stability and better recovery profile as compared to the combined intravenous inhalation of anaesthesia.