摘要
目的比较七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者呼吸动力学的变化。方法选择择期拟行妇科腹腔镜手术患者40例,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为2组(n=20):异丙酚-瑞芬太尼复合麻醉组(PR)和七氟醚-瑞芬太尼复合麻醉组(SR)。麻醉诱导:PR组TCI异丙酚(血浆靶浓度3ug/ml),SR组吸入8%七氟醚,两组均静脉注射瑞芬太尼1ug/kg和顺苯阿曲库铵0.15mg/kg行气管插管。麻醉维持:PR组TCI异丙酚(血浆靶浓度为1.5～3ug/ml),SR组吸入2%～4%七氟醚,两组均TCI瑞芬太尼(血浆靶浓度2.5ng/kg),静脉输注顺阿曲库铵1.2ug.kg-1`.min-1。维持BIS45～50。分别于麻醉诱导前(T0)、气腹前5mi(nT1)、气腹后5mi(nT2)、气腹后15mi(nT3)和气腹放气后15mi(nT4)记录患者PETCO2、气道峰压(Ppeak)和气道平台压(Pplat)的变化,并取动静脉血样行血气分析,计算肺泡肺内分流率(QS/QT)和肺动态顺应性(Cd)。结果与T0比较,T1-3时两组患者QS/QT升高(P<0.05),于T4时QS/QT有所下降,但仍高于T0水平;与T1比较,T2-3时气道峰压(Ppeak)、PETCO2升高,肺顺应性((Cd))降低(P<0.05),于T4时恢复至T1水平;与P组比较,S组T2-3时上述各指标变化更明显(P>0.05)。结论妇科腹腔镜手术患者在腹腔快速充气阶段呼吸变化最明显,与七氟烷麻醉相比,异丙酚麻醉时呼吸动力学影响相对较轻。
Objective To compare the effects of propofol and sevoflurane combined anesthesia on respiratory function in patients undergoing laparoscopic gynecologic surgery.Methods Forty ASA Ⅰor Ⅱ patients undergoing elective gynecological laparoscopic surgery under propofol and sevoflurane combined anesthesia were randomly divided into 2 groups（n=20 each）：propofol group and sevoflurane group.Anesthesia was induced with target-controlled infusion（TCI） of propofol（Ce 3ug/ml） in propofol group or inhalation of 8% sevoflurane in sevoflurane group and iv injection of remifentanil 1ug/kg and cis-atracurium 0.15mg/kg.The patients were tracheal intubated and mechanically ventilated.PETCO2 was maintained at 35～40mmHg.Anesthesia was maintained with TCI of propofol（Ce 1.5～3ug/ml） or 2%～4% sevoflurane inhalation combined with TCI of remifentanil（Ce2.5ng/ml）and cis-atracurium 1.2ug.kg-1.min-1 was infused intravenously.Before anesthesia（T0）,5 min before pneumoperitoneum（T1）,5 and 15 min of pneumoperitoneum（T2,3）and at 15 min after deflation of abdominal（T4）,HR,MAP,Ppeak,PETCO2 and Pplat were recorded.Arterial and mixed venous blood samples were collected for blood gas analysis.Dynamic lung compliance（Cd） and ventilation perfusion ratio（Qs/QT） were calculated at T1-4.Results Ppeak,PETCO2 and Qs/QT were significantly increased and Cd were significantly decreased at T2-3 as compared with the baseline at T1 in both groups（P﹤0.05）.Ppeak,PETCO2 and Qs/QT were higher in group S than in group S at T2-3（P﹤0.05）.Conclusion The effects of respiratory Function is lighter during propofol combined anesthesia than sevoflurane combined anesthesia in patients undergoing gynecological laparoscopic surgery.
出处
《当代医学》
2011年第36期95-97,共3页
Contemporary Medicine
关键词
气腹
呼吸力学
异丙酚
七氟醚
Pneumoperitoneum
Respiratory function
Propofol
Sevoflurane
