異丙酚和瑞芬太尼靶控靜脈麻醉的誘導和術后蘇醒過程評價

張祥鈺+董帥

[摘要] 目的 探討異丙酚和瑞芬太尼靶控靜脈麻醉的誘導和術后蘇醒過程。 方法 將80例ASAⅠ～Ⅱ級擇期行腹腔鏡膽囊切除術患者隨機分為對照組與觀察組各40例。對照組行靜吸復合麻醉，觀察組行異丙酚瑞芬太尼靶控靜脈麻醉。 結果 兩組患者麻醉誘導時，DBP差異有統計學意義（P < 0.05），SBP、MAP及HR相比，差異無統計學意義（P > 0.05）；兩組誘導時各時點OAAS評分差異均有統計學意義（P < 0.05）；兩組患者VRS評分相比，差異均有統計學意義（P < 0.05）；觀察組定向能力恢復時間、離開術后恢復室時間均顯著低于對照組（P < 0.05）。 結論 異丙酚瑞芬太尼靶控靜脈麻醉用于膽囊切除術效果顯著，且蘇醒過程較好，值得在臨床推廣并應用。

[關鍵詞] 異丙酚；瑞芬太尼；靶控靜脈麻醉；術后蘇醒

[中圖分類號] R614 [文獻標識碼] B [文章編號] 1673-9701（2014）02-0090-03

Propofol and remifentanil target-controlled intravenous anesthesia induction and postoperative recovery process evaluation

ZHANG Xiangyu1 DONG Shuai2

1.Department of Anesthesiology， Zhangqiu People's Hospital of Shandong Province， Zhangqiu 250200， China； 2.Department of Neurology， Zhangqiu People's Hospital of Shandong Province， Zhangqiu 250200， China

[Abstract] Objective To investigate the effects of propofol and remifentanil target-controlled intravenous anesthesia induction and postoperative recovery process. Methods A total of 80 patients ASA Ⅰ～Ⅱ grade elective laparoscopic cholecystectomy were divided into control group and observation group randomly according to balloting， 40 cases each. Control group underwent inhalation anesthesia， propofol remifentanil group underwent observation target-controlled intravenous anesthesia. Results Two groups of patients during induction of anesthesia， DBP difference was statistically significant （P < 0.05）， the difference of SBP， MAP and HR was not statistically significant （P > 0.05）； groups induction of the indicators were statistically significant differences （P < 0.05）； The observation group OAAS score at different time had statistically significant differenc compared with the control group（P < 0.05）； Two groups of patients perioperative VRS score of comparison， the differences were statistically significant （P < 0.05）； The observation group targeting capabilities recovery time ， leave the recovery room time were significantly lower than the control group（P < 0.05）. Conclusion Remifentanil target-controlled propofol intravenous anesthesia for cholecystectomy among patients， the effect is significant， and the awakening process is better， it is worth to be promoted and applied in clinic.

[Key words] Propofol； Remifentanil； Target-controlled intravenous anesthesia； Postoperative recovery

關于藥代動力學的靶控輸注在臨床上已經得到了廣泛的應用。與常規的給藥方式相比，靶控輸注可控性較高，且更為簡便精細[1]。該方法是一種主要通過對目標藥物濃度的合理控制來對麻醉深度進行有效控制的麻醉給藥途徑，可按照臨床治療的實際需求，從而對給藥系統加以調整[2]。本研究回顧性分析了2010年7月～2013年7月入住我院的80例行腹腔鏡下膽囊切除術患者的臨床資料，并將靜吸復合麻醉與異丙酚瑞芬太尼靶控靜脈麻醉的效果進行對比分析，現報道如下。endprint

1 資料與方法

1.1 臨床資料

選擇2010年7月～2013年7月入住我院的80例行腹腔鏡下膽囊切除術患者作為研究對象，ASA Ⅰ～Ⅱ級。其中男48例，女32例；年齡21～72歲，平均（50.02±7.72）歲；45例行腹部手術，26例行盆腔手術，9例行顱腦手術。本組全部患者均無嚴重的肝腎功能障礙、心腦血管疾病、嚴重的精神病史以及無長期服用阿片類藥物史。將本組患者按照抽簽方法隨機分為對照組與觀察組各40例，兩組患者在一般資料方面差異無統計學意義（P > 0.05）。