瑞芬太尼在腹腔镜胆囊切除术麻醉中的应用_0.docVIP

瑞芬太尼在腹腔镜胆囊切除术麻醉中的应用 【摘要】 目的：观察瑞芬太尼全凭静脉麻醉在腹腔镜胆囊切除术中的 应用 。 方法 ：选择ASA～级，择期行腹腔镜胆囊切除术的患者50例，随机分为2组，每组25例。R组为瑞芬太尼和丙泊酚诱导和维持，S组为芬太尼和丙泊酚诱导，异氟醚吸入维持。观察两组患者诱导和维持期血流动力学变化，术毕停药后自主呼吸恢复时间，呼之睁眼，拔管时间，定向力恢复时间和离开恢复室(PACU)时间。结果：R组血流动力学变化较小，术毕自主呼吸恢复时间，呼之睁眼，拔管时间，定向力恢复时间和离开恢复室时间较短。结论：瑞芬太尼全凭静脉麻醉在腹腔镜胆囊切除术中，能使手术更平稳，苏醒更佳。 【关键词】 瑞芬太尼 腹腔镜胆囊切除术 全凭静脉麻醉 Application of remifentanil anesthesia in laparoscopic cholecystectomy 【Abstract】Object：To investigate the effect of total intravenous anesthesia with remifentanil in laparoscopic cholecystectomy.Methods： 50 patients(ASA～) undergoing laparoscopic cholecystectomy were randomly divided into two groups(n=25).Group R were given anesthetic induction and maintenance with remifentanil and propofol;while Group S were given anesthetic induction with fentanil and propofol and maintenance with isoflurane. The hemodynamics during induction anesthesia and maintenance anesthesia,and time for stopping administration of anesthetic until full spontaneous respiration,eye opening,trachcal extubation,orientation and discharging from the postanesthetic care unit (PACU) were compared.Results: Anesthesia by remifentanil produces less circulatory fluctuation,and less time for full spontaneous respiration,eye opening,trachcal extubation,orientation and discharging from the PACU than group S. Conclusion: total intravenous anesthesia with remifentanil can be used safely and effectively in laparoscopic cholecystectomy. 【Key words】remifentanil；laparoscopic cholecystectomy；total intravenous anesthesia 腹腔镜胆囊切除术由于创伤小、手术时间短、术后恢复快、住院时间短， 目前 被广泛应用。但由于腹腔镜常气管插管全麻，术中予CO2气腹，故要求术中平稳，术后苏醒快。瑞芬太尼是一种超短效的新型阿片类药。本 研究 是观察两种麻醉方法（瑞芬太尼全凭静脉麻醉和芬太尼、异氟醚为主的传统平衡麻醉）对腹腔镜胆囊切除术的血流动力学和苏醒质量的 影响 。 1 资料和方法 1.1 临床资料 选择ASAⅠ～级，择期行腹腔镜胆囊切除术患者50例，既往无高血压病和其他心血管疾病。随机分为2组，每组25例：R组（瑞芬太尼和丙泊酚诱导和维持），S组（芬太尼和丙泊酚诱导，异氟醚吸入维持）。术前均为肌注阿托品0.5mg，鲁米那0.1。 1.2 麻醉方法 R组：咪唑安定0.04mg/kg，瑞芬太尼1μg/kg（静脉泵入），丙泊酚2mg/kg，阿曲库铵0.6mg/kg诱导结束后90秒气管插管，丙泊酚100μg/kg?min，瑞芬太尼0.1～0.5μg/kg?min维持静脉泵入。S组：咪唑安定0.04mg/kg，芬太尼3μg/kg，丙泊酚2mg/kg，阿曲库铵0.6mg/kg诱导结束后