CAJ | 학술논문

目的:比较3种不同麻醉方法用于腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)对病人围麻醉期循环应激反应及术后恢复的影响.方法:66例年龄18-60岁,ASA Ⅰ～Ⅱ级择期行LC手术病人(n=66),随机分为3组(n=22),瑞芬太尼+七氟烷组(Ⅰ组),芬太尼+异氟烷+丙泊酚组(Ⅱ组),瑞芬太尼+丙泊酚TCI组(Ⅲ组).观察围麻醉期平均动脉压(Meanarterical pressure,MAP)、心率(Heart rate,HR)、血清白介素-6(IL-6)、皮质醇以及血糖浓度的变化与麻醉恢复期各组病人麻醉后恢复时间、Aldrete评分≥9分的时间、术后恶心呕吐发生率以及用视觉模拟评分(Visual analogue scales,VAS)评定术后疼痛.结果:Ⅰ、Ⅱ组插管前MAP下降显著(P＜0.01),Ⅲ组在气腹建立1min后MAP上升显著(P＜0.01).各组血糖,皮质醇水平在手术结束时均显著高于诱导前(P＜0.01).Ⅰ、Ⅲ组IL-6在手术结束时显著增加(P＜0.01).麻醉恢复期Ⅱ组拔管时间、清醒时间、Aldrete评分≥9分时间较Ⅰ、Ⅲ组显著延长(P＜0.05).术后VAS评分,各组比较差异无统计学意义(P＞0.05).术后恶心呕吐各组发生率差异无统计学意义(P＞0.05).结论:3种麻醉方法均适用于LC手术,但用瑞芬太尼+七氟烷或瑞芬太尼+丙泊酚TCI维持麻醉更具恢复时间短、质量高的优点;LC手术可导致机体明显应激反应,术后疼痛明显,恶心呕吐发生率高,应予积极处理.
목적:비교3충불동마취방법용우복강경담낭절제술(Laparoscopic cholecystectomy,LC)대병인위마취기순배응격반응급술후회복적영향.방법:66례년령18-60세,ASA Ⅰ～Ⅱ급택기행LC수술병인(n=66),수궤분위3조(n=22),서분태니+칠불완조(Ⅰ조),분태니+이불완+병박분조(Ⅱ조),서분태니+병박분TCI조(Ⅲ조).관찰위마취기평균동맥압(Meanarterical pressure,MAP)、심솔(Heart rate,HR)、혈청백개소-6(IL-6)、피질순이급혈당농도적변화여마취회복기각조병인마취후회복시간、Aldrete평분≥9분적시간、술후악심구토발생솔이급용시각모의평분(Visual analogue scales,VAS)평정술후동통.결과:Ⅰ、Ⅱ조삽관전MAP하강현저(P＜0.01),Ⅲ조재기복건립1min후MAP상승현저(P＜0.01).각조혈당,피질순수평재수술결속시균현저고우유도전(P＜0.01).Ⅰ、Ⅲ조IL-6재수술결속시현저증가(P＜0.01).마취회복기Ⅱ조발관시간、청성시간、Aldrete평분≥9분시간교Ⅰ、Ⅲ조현저연장(P＜0.05).술후VAS평분,각조비교차이무통계학의의(P＞0.05).술후악심구토각조발생솔차이무통계학의의(P＞0.05).결론:3충마취방법균괄용우LC수술,단용서분태니+칠불완혹서분태니+병박분TCI유지마취경구회복시간단、질량고적우점;LC수술가도치궤체명현응격반응,술후동통명현,악심구토발생솔고,응여적겁처리.
Objective: To investigate the effects of three different anesthetic techniques on pere-anesthesia circulation, stree response and post-anesthesia recovery in patients undergoing leparoscopic cholecystectomy(LC). Methods:Sixty-six ASA Ⅰ or Ⅱ patients aged 18 to 60 undergoing selected LC surgery were randomly divied into 3 groups (n=22).The patients in group I were induced and maintained with remifentanil and sevoflurane.The patients in group Ⅱ with fentanil,propofol and isoflurane,while the patients in group Ⅲ with remifentanil and propofol TCI. MAP and HR were measured before induction,before intubation,at 5 min after intubation, 1 min and 15 min after the establishmen of CO_2 pneumoperitoneum and at the end of operation.Blood cortisol (Cor) and blood glucose (Glu) were measured before induction, after induction 5 min and at the end of operation; Blood interleukin -6(IL-6) was measured before induction and at the end of operation. Postoperative recovery time, Alddret ≥9,the rate of PONV and VAS score were measured on the first postoperative day. Results:There were significant decreases of MAP in group Ⅰ and Ⅱ before intubation (P＜0.01).MAP in group Ⅲ increased significantly 1 min after CO2 pneumoperitoneum was established. Blood IL-6 of Group I and Ⅲ significantly increased at the end of operation ( P＜0.01). Cor and Glu of all three groups were significantly increased at the end of operation compared with those before induction (P＜0.01 ).In anesthesia recovery duration,the times for extubation, recovery and the Aldrete≥9 score were significantly shorter in group Ⅰ and group Ⅲ compared with group Ⅱ (P＜0.01). The rate of PONV and VAS score after operation had no significant differences between either two of the three groups (P ＞ 0.05 ). Conclusion: The three anesthetic techniques can be used safely on LC operation, anesthesia with remifentanil and sevoflurane,anesthesia with remifentanil and propofol TCI have shorter post-operative recovery time and high quality compared with the anesthesia with fentanil,isoflurane and propofol. LC operation can cause obvious stress response of the body,significant postoperative pain and high rate of PONV, which should be actively dealt with.