CAJ | 학술논문

目的：分析不同剂量瑞芬太尼复合丙泊酚麻醉对气腹时患者心血管反应的影响。方法：选取150例需行腹腔镜手术的患者，由电脑随机分为A、B、C三组，每组50例。A、B、C三组患者分别给予瑞芬太尼0.2、0.4、0.6μg/(kg·min)，并复合丙泊酚麻醉，检测三组患者在插管前10 min(T0)、建立气腹前(T1)、建立气腹后5 min(T2)及建立气腹10 min(T3)的平均动脉压(MAP)和心率(HR)指标。结果：三组患者T1时MAP均比T0时显著下降(P<0.05)，A组下降最为明显，与B、C组相比差异均有统计学意义(P<0.05)；T2时MAP均比T1时显著提升(P<0.05)，A组比B组、C组提升明显，差异均有统计学意义(P<0.05)；T3与T2时MAP比较，差异无统计学意义(P>0.05)；T1时HR比T0时显著降低(P<0.05)；A组降低程度明显大于B、C组，差异均有统计学意义(P<0.05)；T2时HR比T1时回升，A组回升程度明显高于B、C组，差异均有统计学意义(P<0.05)；T3与T2时HR比较，差异无统计学意义(P>0.05)。结论：低剂量瑞芬太尼复合丙泊酚麻醉对气腹时心血管影响波动较大，中高剂量的瑞芬太尼复合丙泊酚能有效减轻气腹时患者的心血管反应程度，麻醉效果较好。
목적：분석불동제량서분태니복합병박분마취대기복시환자심혈관반응적영향。방법：선취150례수행복강경수술적환자，유전뇌수궤분위A、B、C삼조，매조50례。A、B、C삼조환자분별급여서분태니0.2、0.4、0.6μg/(kg·min)，병복합병박분마취，검측삼조환자재삽관전10 min(T0)、건립기복전(T1)、건립기복후5 min(T2)급건립기복10 min(T3)적평균동맥압(MAP)화심솔(HR)지표。결과：삼조환자T1시MAP균비T0시현저하강(P<0.05)，A조하강최위명현，여B、C조상비차이균유통계학의의(P<0.05)；T2시MAP균비T1시현저제승(P<0.05)，A조비B조、C조제승명현，차이균유통계학의의(P<0.05)；T3여T2시MAP비교，차이무통계학의의(P>0.05)；T1시HR비T0시현저강저(P<0.05)；A조강저정도명현대우B、C조，차이균유통계학의의(P<0.05)；T2시HR비T1시회승，A조회승정도명현고우B、C조，차이균유통계학의의(P<0.05)；T3여T2시HR비교，차이무통계학의의(P>0.05)。결론：저제량서분태니복합병박분마취대기복시심혈관영향파동교대，중고제량적서분태니복합병박분능유효감경기복시환자적심혈관반응정도，마취효과교호。
Objective:To investigate the effects of different doses of Remifentanil and Propofol to anesthesia in patients’ cardiovascular response during pneumoperitoneum.Method:150 cases of laparoscopic surgery patients were randomly selected by computer and divided into A,B,C three groups,50 cases in each group.A,B and C three groups of patients were given Remifentanil 0.2,0.4 and 0.6 μg/(kg·min), and combined with Propofol anesthesia.Three groups of patients’ mean arterial pressure(MAP) and heart rate(HR) were detected during these steps, pre-intubation 10 min(T0),before establishing pneumoperitoneum(T1),after establishing pneumoperitoneum 5 min(T2) and during establishing pneumoperitoneum 10 min(T3).Result:Three groups of patients’ MAP at T0 all decreased significantly than T1’s MAP(P<0.05).Compared to Group B and C,Group A decreased significantly,the difference of which had statistical meaning (P<0.05).MAP of T2 all significantly increased than T1’s MAP, Group A increased observably than Group B and C,the difference of which had statistical meaning(P<0.05).The MAP of T3 and T2 had no significant difference(P>0.05).HR of T1 was significantly lower than T0’s HR(P<0.05).The decreased degree of Group A was significantly lower than those in Group B and C, the difference of which had statistical meaning(P<0.05).HR of T2 rebounded more than that of T1.Group A’s rebounded degree was significantly higher than Group B and C,the difference of which had statistical meaning(P<0.05).HR of T3 and T2 had no significant difference(P>0.05).Conclusion:Low-dose Remifentanil and Propofol to anesthesia has more impact on cardiovascular response during pneumoperitoneum.A moderate-and-high doses of Remifentanil and Propofol to anesthesia can effectively reduce the response of cardiovascular patients during pneumoperitoneum,which has better effects.