教案靶控输注瑞芬太尼在后腹腔镜非功能性肾上腺肿瘤切除术中的应用.docVIP

靶控输注瑞芬太尼在后腹腔镜非功能性肾上腺肿瘤切除术中的应用 山西医科大学(JShanxiMedUniv)2011年3月,42(3?257? 靶控输注瑞芬太尼在后腹腔镜非功能性肾上腺肿瘤切除术中的应用 钟文晖,刘保江,杨春艳,王建刚(山西医科大学第三医院麻醉科,太原030053;山西医科大学第 一 临床医学院麻醉科;通讯作者,E—mail:1N541001@) 摘要:目的观察靶控输注(TCI)不同血浆浓度瑞芬太尼在非功能性肾上腺肿瘤后腹腔镜手术中对血流动力学变化及应激 反应的影响.方法选择ASAI一Ⅱ级择期行后腹腔镜手术患者45例,随机分为三组,每组15例.均采用TCI瑞芬太尼 复合丙泊酚全静脉麻醉,三组丙泊酚TCI浓度均为3g/nd;I,Ⅱ,Ⅲ组瑞芬太尼的浓度分别为4,6,8ng/ml.监测麻醉前lO min(T,),插管后1rain(T2),后腹膜腔充气后10min(T3),术毕拔除气管导管后1min(T4)的平均动血压(MAP),心率(HR) 和血糖变化.记录术毕呼吸意识恢复时间,观察术后并发症情况.结果j组内MAP在T均较T.明显下降(Plt;0.01), HR在,均较T.明显下降(Plt;0.O1).三组间各时点MAP,HR差异均无统计学意义(Pgt;0.05).三组内L时点血糖均 较T增高(Plt;0.05),而I组升高程度高于Ⅱ,Ⅲ组(Plt;0.o1).术毕恢复情况及不良反应i组间比较差异无统计学意义. 结论TCI6ng/ml瑞芬太尼复合3g/ml丙?白酚,更能维持血流动力学稳定,抑制不良应激反应,有利于患者恢复. 关键词:瑞芬太尼;靶控输注;腹腔镜;腹膜后(间)隙;非功能性肾上腺肿瘤 中图分类号:R614.2文献标志码:A文章编号:1007—661l(2011)03—0257—04DOI:tO.3969/J.ISSN.1007—6611.2011.03.024 Applicationoftargetcontrolinfusionofremifentanilinretroperitoneallaparoscopicadrenalectomyfornonfunctionaladrenal tumors ZHONGWen—hui,LIUBao-jiang,YANGChun—yan,WANGJian—gang(DeptofAnesthesiology,ThirdHospital,ShanxiMedical University,Ta@uan030053,China2DeptofAnesthesiology,FirstClinicalMedicalCollege,ShanxiMedicalUniversity;Corresponding author.E—mail:lbj541001@) Abstract:0ctiveToexploretheeffectsoftargetcontrolinfusionofdifferentconcentrationsofremifentanilonhemodynamicsand stressreactioninretroperitoneallaparoscopicadrenalectomyfornonfunctionaladrenaltumors.MethodsForty—fiveASAI～Ⅱpa— tientsundergoingelectiveretroperitoneallaparoscopicadrenalectomyfornonfunctionaladrenaltumorsweredividedintothreegroups: low,middleandhighdosegroups.Allpatientsweregiventargetcontrolledinfusionofremifentanilandpropfo1.In3groups,thetarget plasmaconcentrationofremifentanilwassetat4,6and8ng/mlrespectively,andpropfolat3g/m1.Meanarterialpressure(MAP), heartrate(HR)andbloodglucoseweremonitoredandrecordedat10minbeforeanesthesia(T1),1minaftertrachealintubation(T2), 10rainafterpneumoperitoneum(T3)and1minafterwithdrawaloftrachealcatheter(T4).Therecoverytimeofspontaneousbreathing andawarenesswasrecordedaftero