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目的评价雷米芬太尼、丙泊酚联用持续微泵泵注全身麻醉应用于腹腔镜子宫次全切除术的效果。方法2006年1月至9月在中国医科大学附属第二医院选择60例ASAI～Ⅱ级择期腹腔镜子宫次全切除手术的患者,随机分为雷米芬太尼联用丙泊酚持续微泵泵注麻醉(观察组)30例和丙泊酚持续微泵泵注麻醉(对照组)30例。分别于气腹前,气腹后5min、10min和手术后(放气后)5min测定血流动力学指标,同时抽血用高效液相色谱—电化学检测血浆去甲肾上腺素(NE)和肾上腺素(E)水平。结果血流动力学变化:与观察组比较,对照组气腹形成后收缩压和舒张压均有上升,术后渐恢复至气腹前水平。应激反应:与观察组比较,对照组气腹时血浆NE、E水平均明显增加(P<0.05)。观察组手术结束后(3.2±1.5)min清醒,对照组手术结束后(7.8±2.7)min清醒,给予拔除气管导管,两组差异有显著性意义(P<0.05),观察组麻醉后并发症少。结论雷米芬太尼、丙泊酚联用持续微泵泵注麻醉可降低腹腔镜手术中气腹形成时对患者机体的血流动力学和应激反应的影响,安全可靠。
Objective To evaluate the effect of remifentanil and propofol combined with sustained micro-pump on general anesthesia in laparoscopic subtotal hysterectomy. Methods From January 2006 to September 2006, 60 patients with ASAI stage Ⅱ elective hysterectomy undergoing secondary elective hysterectomy in the Second Affiliated Hospital of China Medical University were randomly divided into three groups: remifentanil with propofol sustained micro-pump Thirty patients were anesthetized with pump (observation group) and 30 patients were anesthetized with propofol sustained micropump (control group). The hemodynamic parameters were measured before pneumoperitoneum, 5 min after pneumoperitoneum, 10 min and 5 min after the operation (after deflation), respectively. Meanwhile, blood samples were collected for plasma norepinephrine (NE) and adrenal Prime (E) level. Results Hemodynamic changes: Compared with the observation group, the systolic and diastolic blood pressure of the control group increased after pneumoperitoneum, and gradually recovered to the level before pneumoperitoneum. Stress reaction: compared with the observation group, the control group pneumoperitoneum plasma NE, E levels were significantly increased (P <0.05). The observation group was awakened after (3.2 ± 1.5) min and the control group was awakened (7.8 ± 2.7) min after the operation, and the tracheal extubation was given. There was significant difference between the two groups (P <0.05) less. Conclusion Remifentanil and propofol combined with sustained micro-pump anesthesia can reduce the influence of pneumoperitoneum on hemodynamics and stress response in patients with pneumoperitoneum during laparoscopic surgery, which is safe and reliable.