丙泊酚聯(lián)合瑞芬太尼靶控輸注在腹腔鏡宮外孕手術(shù)中的臨床應(yīng)用

[摘要] 目的 探討丙泊酚聯(lián)合瑞芬太尼靶控輸注在腹腔鏡宮外孕手術(shù)中的臨床效果。 方法 回顧分析2010年1月～2013年3月我院腹腔鏡行宮外孕手術(shù)患者120例，隨機(jī)分為觀察組和對(duì)照組，每組60例。觀察組采用丙泊酚聯(lián)合瑞芬太尼進(jìn)行麻醉，對(duì)照組采用丙泊酚聯(lián)合芬太尼進(jìn)行麻醉。記錄患者術(shù)中循環(huán)系統(tǒng)變化及術(shù)后相關(guān)情況。 結(jié)果 觀察組麻醉后收縮壓（SBP）、心率（HR）較麻醉前明顯下降，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；觀察組在麻醉后、氣腹后循環(huán)系統(tǒng)波動(dòng)小于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05），觀察組術(shù)后喚醒時(shí)間、蘇醒延遲明顯優(yōu)于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；術(shù)后嗆咳、躁動(dòng)及術(shù)中知曉兩組差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。 結(jié)論 丙泊酚聯(lián)合瑞芬太尼雖在麻醉誘導(dǎo)早期容易出現(xiàn)血壓、心率下降，但在氣腹后及麻醉中能夠維持循環(huán)系統(tǒng)的穩(wěn)定，減少應(yīng)激反應(yīng)。

[關(guān)鍵詞] 丙泊酚；瑞芬太尼；腹腔鏡；宮外孕

[中圖分類號(hào)] R614.2+4 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 2095-0616（2013）13-99-03

Clinical application of propofol combined with remifentanil target controlled infusion on laparoscopy ectopic pregnancy

LIU Yibing ZHONG Shenghua ZHOU Yufeng

Department of Anesthesiology，Dongguan Qishi Hospital of Guangdong Province，Dongguan 523500，China

[Abstract] Objective To discuss the clinical effect of propofol combined with remifentanil target controlled infusion on laparoscopy ectopic pregnancy. Methods 120 cases of patients who cured by laparoscopic ectopic pregnancy surgery were selected，and divided into the observation group and the control group，60 cases in each group，the observation group used propofol combined with remifentanil for anesthesia，the control group used propofol combined with fentanyl for anesthesia，and then recorded the intraoperative circulation system changes and the postoperative relevant informations. Results The systolic blood pressure（SBP）and heart rate（HR）of the observation group after anesthesia declined compared with that before anesthesia（P<0.05）；the circulatory fluctuation of the observation group was less than the control group after anesthesia and after pneumoperitoneum（P<0.05）；the wake up time and wake up delay of the observation group were better than the control group after surgery（P<0.05）.The postoperative cough，agitation and intraoperative awareness of the two groups had no significant difference（P>0.05）. Conclusion Using propofol combined with remifentanil in the early anesthesia induction can lead to a drop in blood pressure and heart rate，but it is able to maintain circulation system stability after pneumoperitoneum and anesthesia，and it can reduce the stress response.

[Key words] Propofol；Remifentanil；Laparoscope；Ectopic pregnancy

宮外孕是臨床婦科常見的急腹癥，隨著人工流產(chǎn)，剖宮產(chǎn)的增多，性交年齡提前等因素，其發(fā)病率呈逐年增高[1]。丙泊酚作為快速高效全身麻醉藥物，具有起效快，代謝迅速的特點(diǎn)，是臨床麻醉誘導(dǎo)的重要藥物。瑞芬太尼作為新型阿片受體激動(dòng)藥，具有高效，迅速，不經(jīng)過(guò)肝腎代謝的特點(diǎn)，更適合于宮外孕手術(shù)麻醉。我院在腹腔鏡宮外孕手術(shù)中采用丙泊酚聯(lián)合瑞芬太尼進(jìn)行麻醉，取得滿意的臨床效果，報(bào)道如下。

1 資料與方法

1.1 一般資料

回顧分析2010年1月～2013年3月我院在腹腔鏡下行宮外孕手術(shù)的患者120例，年齡17～45歲，平均（26.5±4.3）歲?！?br>