CAJ | 학술논문

目的观察瑞芬太尼分步靶控输注全麻对老年患者腹腔镜下胆囊切除术时应激反应抑制、循环和苏醒的影响.方法 60例ASA Ⅰ一Ⅲ患者随机分成4组,每组15例.麻醉诱导时A组、B组、C组和D组分别给予0.06 ms/kg芬太尼、血浆靶浓度4.0μ/L输入芬太尼、血浆靶浓度4.0μg/L输入瑞芬太尼及血浆靶浓度从2.0μg/L分阶段增至4.0μg/L输入瑞芬太尼,同时给予血浆靶浓度3.0μg/L异丙酚及维库溴胺完成麻醉诱导.除B组在胆囊取出后停止芬太尼输入外,各组所有药物均在术毕时停止输入.予10、T1、T2、T3和T4点记录血流动力学参数及测定血清皮质醇、醛固酮和血糖浓度.记录苏醒拔管时间、术毕至出恢复审时间、拔管时OAA/S评分和从术毕至OAA/S评分达5分时间.记录麻醉手术过程中血管活性药物应用情况.结果 4组患者在麻醉诱导时MAP及HR均有不同程度下降,C组最为明显,MAP及HR分别下降至(59±12)mm Hg和(54±6)次/min(P<0.05);4组患者苏醒拔管时MAP及HR均增加,A、B两组增加显著,分别增高至(113±13)mm Hg、(81μ8)次.min和(110μ12)mm Hg、(80μ7)次/min(P<0.05);A、B两组T4点皮质醇、醛固酮浓度比T0点明显增高(P<0.05);C组阿托品、麻黄碱、艾司洛尔和乌拉地尔使用总次数为20次,比其余3组明显增加(P<0.05).C、D两组拔管时间、出恢复室时间和OAA/S评分至5分时间比A、B两组明显缩短(P<0.05);C、D两组拔管时OAA/S评分明显高于A、B两组(P<0.05).结论瑞芬太尼TCI可有效抑制老年患者气管插管和上腹部手术等刺激引起的应激反应,苏醒迅速且质量高,分步TCI时循环更加平稳.
목적 관찰서분태니분보파공수주전마대노년환자복강경하담낭절제술시응격반응억제、순배화소성적영향.방법 60례ASA Ⅰ일Ⅲ환자수궤분성4조,매조15례.마취유도시A조、B조、C조화D조분별급여0.06 ms/kg분태니、혈장파농도4.0μ/L수입분태니、혈장파농도4.0μg/L수입서분태니급혈장파농도종2.0μg/L분계단증지4.0μg/L수입서분태니,동시급여혈장파농도3.0μg/L이병분급유고추알완성마취유도.제B조재담낭취출후정지분태니수입외,각조소유약물균재술필시정지수입.여10、T1、T2、T3화T4점기록혈류동역학삼수급측정혈청피질순、철고동화혈당농도.기록소성발관시간、술필지출회복심시간、발관시OAA/S평분화종술필지OAA/S평분체5분시간.기록마취수술과정중혈관활성약물응용정황.결과 4조환자재마취유도시MAP급HR균유불동정도하강,C조최위명현,MAP급HR분별하강지(59±12)mm Hg화(54±6)차/min(P<0.05);4조환자소성발관시MAP급HR균증가,A、B량조증가현저,분별증고지(113±13)mm Hg、(81μ8)차.min화(110μ12)mm Hg、(80μ7)차/min(P<0.05);A、B량조T4점피질순、철고동농도비T0점명현증고(P<0.05);C조아탁품、마황감、애사락이화오랍지이사용총차수위20차,비기여3조명현증가(P<0.05).C、D량조발관시간、출회복실시간화OAA/S평분지5분시간비A、B량조명현축단(P<0.05);C、D량조발관시OAA/S평분명현고우A、B량조(P<0.05).결론 서분태니TCI가유효억제노년환자기관삽관화상복부수술등자격인기적응격반응,소성신속차질량고,분보TCI시순배경가평은.
Objective To observe the restrain of stress reaction,circulation stability and the pal-inesthesia from anaesthesia during a step-by-step target-controlled infusion (TCI) of remifentanil in elderly patients under laparoscopic cholecystectomy. Methods Sixty ASA class Ⅰ -Ⅱ patients were randomly di- vided into 5 groups:15 ease each group. A dose of 0.06 mg/kg fentanyl was given in group A,4.0 μg/L blood plasma target level of fentanyl was given in group B,4.0 μg/L blood plasma target level of remifen-tanil was given in group C, and blood plasma target level of remifentanil was given from 2.0 μg/L to 4.0 μg/L step by step in group D during anesthesia. Midazolam, propofol and vecuronium bromide were also given during anesthesia induction. Hemodynamic parameters at T0, T1, T2, T3 and T4 were recorded, and the concentrations of serum corticosteroid, aldosterone and blood sugar determined. The time of extubation, return to ward ,OAA/S score after extubation ,and OAA/S score to 5 was recorded. The use of vasoactive a- gent during operations was also recorded. Results MAP and HR were decreased during anesthesia induc- tion in 4 groups,and more significant in group C (P <0.05 ). MAP and HR were increased during trachea extubation in 4 groups,and more significant in groups A, B (P < 0.05 ). The concentrations of corticoste-roid and aldosterone were increased significantly at T4 compared to T0(P < 0.05 ). The frequency of using vasoactive agents was increased significantly in group C(P < 0.05 ). The time of extubataion, leaving PACU, and OAA/S score to 5 was significantly shortened in groups C, D(P < 0.05 ). The OAA/S scores were significantly higher in groups C, and D than in groups A, and B(P < 0.05 ). Conclusion TCI of remifentanil can restrain stress reaction caused by tracheal intubation and operation stimulation effectively, and provide quickly palinesthesia with high quality in elderly patients, but a step-by-step TCI of remifen- tanil can provide more stable circulation.