瑞芬太尼复合丙泊酚对腹腔镜胆囊切除术患者血流动力学的影响
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[摘要] 目的 探讨瑞芬太尼复合丙泊酚对腹腔镜胆囊切除术（LC）患者血流动力学的影响。 方法 选取我院2009年1月～2012年1月行腹腔镜胆囊切除术患者80例，随机分为I组（瑞芬太尼复合丙泊酚）和II组（芬太尼复合丙泊酚）各40例，比较两组患者气腹前、气腹后10 min、拔管时血压、心率的变化以及两组患者麻醉恢复情况。 结果 I组拔管时SBP较气腹前明显升高，但与气腹后10 min比较未见明显变化；而II组拔管时SBP较I组明显升高。I组拔管时DBP虽然较气腹前及气腹后10 min有所升高，但组间及组内差异不显著，而Ⅱ组气腹后10 min、拔管时的DBP值分别较气腹前显著升高，且明显高于I组 （P < 0.05）。I组拔管时心率明显增快。I组自主呼吸恢复时间快、呼之睁眼时间快，拔管时间早，恶心呕吐发生率低，差异有显著性（P < 0.05）。 结论 瑞芬太尼复合丙泊酚应用于腹腔镜阑尾切除术麻醉效果确切，血流动力学稳定，苏醒迅速，安全性高，值得广泛推广和应用。
[关键词] 瑞芬太尼；丙泊酚；腹腔镜胆囊切除术；血流动力学
[中图分类号] R614 [文献标识码] B [文章编号] 1673—9701（2012）25—0092—02
Remifentanil and propofol laparoscopic cholecystectomy in patients with hemodynamic
ZHU Xiliang LIU Xihao LOU Pinzhi
Department of Aneshesiology，Pizhou City Traditional Chinese Medicine Hospital，Pizhou 221300，China
[Abstract] Objective To investigate the effects and hemodynamic of remifentanil and propofol for laparoscopic cholecystectomy surgery （LC） patients. Methods 80 cases patients with laparoscopic cholecystectomy patients in our hospital from January 2009 to January 2012 were randomly divided into group I（remifentanil and propofol）and group II （fentanyl propofol phenol），each group 40 cases，two groups were compared pneumoperitoneum，after pneumoperitoneum 10 min，the time of extubation，blood pressure，heart rate changes，as well as two groups of patients anesthesia recovery. Results I extubation SBP compared with before pneumoperitoneum was significantly increased，but no significant changes in pneumoperitoneum 10 min. After extubation of the Group II SBP compared with the group I was significantly higher. I extubation when DBP than pneumoperitoneum and pneumoperitoneum after 10min was increased，the group and within—group differences were not significant，Group II gas abdomen after 10 min，extubation，DBP value respectively over the pneumoperitoneum significantly increased，and significantly higher than group I（P < 0.05）. I group extubation，heart rate was significantly faster. Group I of spontaneous breathing faster recovery time，respiratory，eye opening time，early extubation， nausea， vomiting and a low incidence，the difference was significant（P < 0.05）. Conclusion Remifentanil and propofol used in laparoscopic appendectomy exact anesthetic effect of resection， hemodynamic stability， recovery is rapid， safe， and worthy of extensive promotion and application.
[Key words] Remifentanil； Propofol； Laparoscopic cholecystectomy； Hemodynamic
腹腔镜胆囊切除术以其创伤小、术后恢复快等优点目前广泛应用于临床。麻醉效果的好坏对手术的成功和患者的安全具有重要的影响，尤其CO2气腹的建立会激活机体的应激系统，从而产生较大的血流动力学波动[1]。瑞芬太尼是一种新型的μ受体激动剂，研究证实其具有起效迅速、能有效抑制气管插管和手术应激时的高血压反应[2]且患者苏醒快等优点，但关于其复合丙泊酚对腹腔镜胆囊切除术患者血流动力学的影响的报道较少。本研究旨在探讨瑞芬太尼复合丙泊酚对腹腔镜胆囊切除术患者血流动力学的影响，现报道如下。