老年患者腹腔镜胆囊切除术全麻维持的临床研究.docVIP

老年患者腹腔镜胆囊切除术全麻维持的临床研究 　　摘 要 目的：探讨老年患者腹腔镜胆囊切除术全麻维持的临床研究。方法：选取70岁以上行腹腔镜胆囊切除术老年患者80例随机分为A、B两组各40例：A组使用右美托咪定+瑞芬太尼麻醉维持，B组采用丙泊酚+瑞芬太尼麻醉维持。观察记录患者不同时间点的心率（HR）、平均动脉压（MAP）和脑电双频指数值（BIS）值。术后对两组患者进行改良OAA/S评级及Steward苏醒评分并观察记录苏醒时间、不良反应情况。结果：两组患者BIS在不同时间点差异无统计学意义；在各时间点A组患者的HR、MAP明显低于B组，且相邻两个时间点A组患者HR、MAP变化幅度小于B组（P0.05）；术后两组患者改良OAA/S评级、Steward苏醒评分及苏醒时间比较差异无统计学意义。结论：老年患者行腹腔胆囊切除术时采用右美托咪定取代丙泊酚作为麻醉镇静剂，对患者术中麻醉维持时血流动力学影响小，安全性好，效果显著。 　　关键词 老年患者 腹腔镜手术 麻醉 右美托咪定 　　中图分类号：R657.4； R614.24 文献标识码：B 文章编号：1006-1533（2016）23-0042-03 　　Clinical study on the maintenance of general anesthesia in elderly patients undergoing laparoscopic cholecystectomy* 　　LI Shiming**， YANG Xiaoying， ZHENG Yanping 　　（Department of Anesthesia， the People’s Hospital of Boyang County， Shangrao 333100， China） 　　ABSTRACT Objective： To investigate the clinical study on laparoscopic cholecystectomy in elderly patients undergoing laparoscopic cholecystectomy. Methods： Eighty cases of elderly patients over 70 years old underwent laparoscopic cholecystectomy were randomly divided into group A （dexmedetomidine + remifentanil） and B （propofol + remifentanil） with 40 cases each. Heart rate （HR）， mean arterial pressure （MAP） and bispectral index （BIS） at different time points were investigated. The patients were assessed by the modified OAA/S rating and Steward recovery score and the recovery time and the adverse reaction were observed after the operation. Results： The comparison of BIS at different time points showed no statistical significance. HR and MAP were significantly slower or lower in group A than group B and the changes of HR and MAP at two adjacent time points were less in group A than group B （P0.05）. After the operation， there were no significant differences between the two groups in the modified OAA/S rating， Steward recovery rating and recovery time. Conclusion： Replacement of propofol with dexmedetomidine as analgesics for elderly patients undergoing laparoscopic cholecystectomy has small hemodynamic effect，