CAJ | 학술논문

目的比较腹腔镜胆囊切除术患者异丙酚复合瑞芬太尼与七氟醚麻醉的效果.方法择期行腹腔镜胆囊切除术患者120例,ASA Ⅰ或Ⅱ级,年龄18～64岁,体重45～80kg,性别不限,随机分为异丙酚复合瑞芬太尼组(PR组)和七氟醚组(S组),每组60例.麻醉诱导:PR组异丙酚效应室靶浓度3μl/ml,瑞芬太尼效应室靶浓度6 ng/ml;S组高流量吸入8%七氟醚-氧化亚氮.麻醉维持:PR组异丙酚效应室靶浓度2～3μg/ml,瑞芬太尼效应室靶浓度2～6 ng/ml;S组维持七氟醚呼气末浓度1.3%～2.2%.记录诱导时间、麻醉时间、睁眼时间、拔管时间、手术时间和PACU停留时间;于拔管后即刻、拔管后30、60 min和离开PACU时采用警觉/镇静评分(OAA/S)评价意识状态;于术前和术后1 h采用MMSE简易智能量表评价认知功能;PACU期间采用VAS评分评价疼痛程度,并记录芬太尼的用量和使用情况;记录术中血管活性药物的使用情况;记录术中和PACU期间不良反应发生情况;于术后24 h进行随访,记录术中知晓的发生情况及患者对麻醉的满意情况.结果与PR组比较,S组诱导时间缩短,睁眼时间和PACU停留时间延长,拔管后即刻和拔管后30 min时OAA/S评分降低,PACU期间芬太尼使用率和芬太尼用量降低,恶心呕吐发生率升高,术中降压药使用率升高(P＜0.05或0.01);两组术前及术后1 h时MMSE评分均在24分以上;两组诱导过程中胸壁强直、咳嗽和喉痉挛和窒息感的发生率、患者对麻醉满意率差异无统计学意义(P＞0.05).结论腹腔镜胆囊切除术患者异丙酚复合瑞芬太尼麻醉或七氟醚麻醉的效果较好,两种麻醉方法之间无绝对的优势.
목적 비교복강경담낭절제술환자이병분복합서분태니여칠불미마취적효과.방법 택기행복강경담낭절제술환자120례,ASA Ⅰ혹Ⅱ급,년령18～64세,체중45～80kg,성별불한,수궤분위이병분복합서분태니조(PR조)화칠불미조(S조),매조60례.마취유도:PR조이병분효응실파농도3μl/ml,서분태니효응실파농도6 ng/ml;S조고류량흡입8%칠불미-양화아담.마취유지:PR조이병분효응실파농도2～3μg/ml,서분태니효응실파농도2～6 ng/ml;S조유지칠불미호기말농도1.3%～2.2%.기록유도시간、마취시간、정안시간、발관시간、수술시간화PACU정류시간;우발관후즉각、발관후30、60 min화리개PACU시채용경각/진정평분(OAA/S)평개의식상태;우술전화술후1 h채용MMSE간역지능량표평개인지공능;PACU기간채용VAS평분평개동통정도,병기록분태니적용량화사용정황;기록술중혈관활성약물적사용정황;기록술중화PACU기간불량반응발생정황;우술후24 h진행수방,기록술중지효적발생정황급환자대마취적만의정황.결과 여PR조비교,S조유도시간축단,정안시간화PACU정류시간연장,발관후즉각화발관후30 min시OAA/S평분강저,PACU기간분태니사용솔화분태니용량강저,악심구토발생솔승고,술중강압약사용솔승고(P＜0.05혹0.01);량조술전급술후1 h시MMSE평분균재24분이상;량조유도과정중흉벽강직、해수화후경련화질식감적발생솔、환자대마취만의솔차이무통계학의의(P＞0.05).결론 복강경담낭절제술환자이병분복합서분태니마취혹칠불미마취적효과교호,량충마취방법지간무절대적우세.
Objective To compare the efficacy of anesthesia with TGI of propofol-remifentanil and sevoflurane for laparoscopic cholecystectomy.Methods One-hundred and twenty ASA Ⅰ or Ⅲ patients of both sexes aged 18-64 yr weighing 45-80 kg undergoing elective laparoscopic cholecystectomy were randomly divided into 2 groups(n=60 each):group Ⅰ propofol-remifentanil(PR)and group Ⅱ sevoflurane(S).In group PR anesthesia was induced and maintained with TCI of propofol-remifentanil.The target effect-site concentration of propofol and remifentanil were set at 3μg/ml and 6 ng/ml during induction and at 2-3 μg/ml and 2-6 ng/ml during maintenance of anesthesia respectively.In group S anesthesia was induced with 8%sevoflurane-50%N2O-O2(FGF=10 L/min)and fentanyl 2 μg/kg and maintained with 1.3%-2.2%sevoflurane-50%N2O-O2(FGF=2 L/min).All patients were intubated and mechanically ventilated.Tracheal intubation was facilitated with vecuronium 0.1 mg/kg.The following variables were recorded:duration of induction;eye-opening time;extubation time;duration of anesthesia and operation;length of stay in PACU;OAA/S scores(5=fully awake,1=asleep)immediately and at 30,60 min after extubation and while leaving PACU;MMSE before anesthesia and 1 h after operation;the number of the patients who needed fentanyl for analgesia and the amount of fentanyl given;the vasoactive drugs used during operation;complications during operation and stay in PACU and awareness.Results The duration of induction was significantly shorter,eye-opening time and the length of stay in PACU were longer,and the OAA/S scores immediately and at 30 min after extubation were lower in group S than in group PR.Less patients needed fentanyl for analgesia in PACU and the amount of fentanyl was less,the antihypertensive used during operation and the incidence of postoperative nausea and vomiting were higher in group S than in group PR.The majority of the patients in both groups(98%)were happy with the anesthesia they received and would choose the same anesthetics again if needed.Conclusion Each technique has its advantage and disadvantage for laparoscopic cholecystectomy.