中国实用医药
中國實用醫藥
중국실용의약
CHINA PRACTICAL MEDICAL
2009年
18期
5-8
,共4页
瑞芬太尼%异丙酚%靶控输注%腹腔镜胆囊切除术%老年人
瑞芬太尼%異丙酚%靶控輸註%腹腔鏡膽囊切除術%老年人
서분태니%이병분%파공수주%복강경담낭절제술%노년인
Remifentanil%Propofol%Target-controlled infusion%Laparoscopic cholecystectomy%Elderly
目的 探讨异丙酚复合瑞芬太尼靶控输注(Target-controlled infusion, TCI) 全凭静脉麻醉用于老年人腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)的可行性及安全性.方法 择期LC手术老年患者56例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级I-Ⅱ级,心肺功能正常. 随机等分为静吸麻醉组(I组)和静脉全麻组(T组),两组均以咪选唑仑、异丙酚、芬太尼、雏库溴铵诱导后做气管插管.麻醉维持:静吸麻醉组(I组, n=28例)采用3%异氟醚吸入诱导,1%～2.5%维持,间断辅以瑞芬太尼静注;全凭静脉组(T组, n=28例)将瑞芬太尼和异丙酚混合液持续恒速输入, 诱导时设定瑞芬太尼血浆靶浓度为4～8ng/ml,异丙酚为3～5μg/ml,术中根据血压、心率调整靶浓度. 术中监测心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)等指标及手术结束至自主呼吸、睁眼、拔除气管导管、恢复定向能力的时间等.结果 两组间的拔管时间、清醒程度有显著差异.静吸麻醉组(I组)在气腹后10 min的HR、SBP、DBP及术毕明显高于术前基础值(P＜0.05或P＜0.01),而全凭静脉组术中无明显变化,术后恶心呕吐发生率也明显低于静吸组.结论 异丙酚复合瑞芬太尼靶控输注静脉麻醉用于老年人腹腔镜胆囊切除术可达满意的麻醉深度,具有苏醒快,围术期血压、心率变化幅度小,能降低术后恶心呕吐的发生, 患者安全系数高等优点, 且无吸入麻醉药的手术室空气污染, 优于异氟醚吸入麻醉方法 .
目的 探討異丙酚複閤瑞芬太尼靶控輸註(Target-controlled infusion, TCI) 全憑靜脈痳醉用于老年人腹腔鏡膽囊切除術(Laparoscopic Cholecystectomy,LC)的可行性及安全性.方法 擇期LC手術老年患者56例,美國痳醉醫師協會(American Society of Anesthesiologists,ASA)分級I-Ⅱ級,心肺功能正常. 隨機等分為靜吸痳醉組(I組)和靜脈全痳組(T組),兩組均以咪選唑崙、異丙酚、芬太尼、雛庫溴銨誘導後做氣管插管.痳醉維持:靜吸痳醉組(I組, n=28例)採用3%異氟醚吸入誘導,1%～2.5%維持,間斷輔以瑞芬太尼靜註;全憑靜脈組(T組, n=28例)將瑞芬太尼和異丙酚混閤液持續恆速輸入, 誘導時設定瑞芬太尼血漿靶濃度為4～8ng/ml,異丙酚為3～5μg/ml,術中根據血壓、心率調整靶濃度. 術中鑑測心率(heart rate,HR)、收縮壓(systolic blood pressure,SBP)、舒張壓(diastolic blood pressure,DBP)、平均動脈壓(mean arterial pressure,MAP)等指標及手術結束至自主呼吸、睜眼、拔除氣管導管、恢複定嚮能力的時間等.結果 兩組間的拔管時間、清醒程度有顯著差異.靜吸痳醉組(I組)在氣腹後10 min的HR、SBP、DBP及術畢明顯高于術前基礎值(P＜0.05或P＜0.01),而全憑靜脈組術中無明顯變化,術後噁心嘔吐髮生率也明顯低于靜吸組.結論 異丙酚複閤瑞芬太尼靶控輸註靜脈痳醉用于老年人腹腔鏡膽囊切除術可達滿意的痳醉深度,具有囌醒快,圍術期血壓、心率變化幅度小,能降低術後噁心嘔吐的髮生, 患者安全繫數高等優點, 且無吸入痳醉藥的手術室空氣汙染, 優于異氟醚吸入痳醉方法 .
목적 탐토이병분복합서분태니파공수주(Target-controlled infusion, TCI) 전빙정맥마취용우노년인복강경담낭절제술(Laparoscopic Cholecystectomy,LC)적가행성급안전성.방법 택기LC수술노년환자56례,미국마취의사협회(American Society of Anesthesiologists,ASA)분급I-Ⅱ급,심폐공능정상. 수궤등분위정흡마취조(I조)화정맥전마조(T조),량조균이미선서륜、이병분、분태니、추고추안유도후주기관삽관.마취유지:정흡마취조(I조, n=28례)채용3%이불미흡입유도,1%～2.5%유지,간단보이서분태니정주;전빙정맥조(T조, n=28례)장서분태니화이병분혼합액지속항속수입, 유도시설정서분태니혈장파농도위4～8ng/ml,이병분위3～5μg/ml,술중근거혈압、심솔조정파농도. 술중감측심솔(heart rate,HR)、수축압(systolic blood pressure,SBP)、서장압(diastolic blood pressure,DBP)、평균동맥압(mean arterial pressure,MAP)등지표급수술결속지자주호흡、정안、발제기관도관、회복정향능력적시간등.결과 량조간적발관시간、청성정도유현저차이.정흡마취조(I조)재기복후10 min적HR、SBP、DBP급술필명현고우술전기출치(P＜0.05혹P＜0.01),이전빙정맥조술중무명현변화,술후악심구토발생솔야명현저우정흡조.결론 이병분복합서분태니파공수주정맥마취용우노년인복강경담낭절제술가체만의적마취심도,구유소성쾌,위술기혈압、심솔변화폭도소,능강저술후악심구토적발생, 환자안전계수고등우점, 차무흡입마취약적수술실공기오염, 우우이불미흡입마취방법 .
Objective To investigate the feasibility and security of target-controlled infusion with remifentanil and propofol to the elderly laparoscopic cholecystectomy. Methods Fifty-six elderly patients undergoing selected LC,grade I-II of American Society of Anesthesiologjsts (ASA),with normal cardiac and lung function, were randomly divided into 2 groups of 28 patients each:inhalation anesthesia group (I-group) and intravenous anesthesia group(T-group).Following induction with midazolam, propofol, remifentanil and vecuronium,anaesthesia was maintained with remifentanil/ isoflurane in I-group or remifentanil/propofol in T-group.I-group was induced by by 3% isoflurane inhalation and maintained with 1%～2.5%. The target plasma concentration of remifentanil was 4-8ng/ml and propofol was 3-5ug/ml in T-group. The concentration was adjusted with blood pressure and heart rate. HR(heart rate), SBP(systolic blood pressure), DBP (diastolic blood pressure), MAP(mean arterial pressure) were monitored continuously in two groups during operation.The interval time from the end of operation to spontaneous respiration,eyes-opening, extubation and orientation were recorded. Results In the two groups, there were significant difference in extubation time and awake extent. The HR、SBP、DBP of pneumoperitoneum after 10 min and after surgery were much higher than that of preoperation, while there was no obvious change in T-group. The induction time and incidence of nausea and vomiting after surgery were also much less in T-group than I-group. The vital signs were stable in T-group during operation.The patients in T-group gained more comfortable recovery than those in I-group.Conclusions Target-controlled infusion with remifentanil and propofol to the elderly laparoscopic cholecystectomy can get satisfied depth of anesthesia and better recovery. So the anaesthesia maintained by propofol target controlled infusion for lapamscopic choleeystectomy is better than that by isoglurane inhalation.
