摘要
目的 对丙泊酚复合雷米芬太尼或氧化亚氮用于妇科腹腔镜诊疗术后麻醉苏醒、早期拔管进行比较。方法 选择ASA Ⅰ级，临床诊断不孕，拟于气管内插管的全麻下择期行腹腔镜检查及治疗的患者45例，随机分为三组：丙泊酚3μg／ml组（A组），丙泊酚2μg／ml组（B组）和氧化亚氮组（C组），每组15例。三组患者均为丙泊酚靶控输注（TCI）给药诱导及术中维持麻醉，罗库溴铵维持肌松。A组：维持丙泊酚靶浓度3μg／ml不变，雷米芬太尼根据血液动力学变化按0～1μg·kg^-1·min^-1输注给药，维持血液动力学稳定。B组：维持丙泊酚靶浓度2μg／ml不变，同样通过调整雷米芬太尼的给药速度维持血液动力学稳定。C组：丙泊酚TCI诱导，气管内插管后伍用氧化亚氮吸入维持麻醉。呼气末氧化亚氮浓度保持（65±1）％，通过调整丙泊酚的靶浓度来维持血液动力学稳定。三组患者均在手术结束时同时停麻醉药。以停麻醉的时间为零点计时，记录呼患者睁眼时间、气管拔管时间及答问切题时间。结果在睁眼时间、拔管时间和答问切题时间三项观察指标中，各组之间差异均有极显著意义（P〈0．01）。B组患者睁眼时间（4．5±2．1）min、拔管时间（5．4±2．3）min、答问切题时间（8．1±2．8）min最短，说明麻醉苏醒最快；C组分别为（11．6±3．4）、（12．7±3．6）、（20．2±4．5）min，患者苏醒最慢；A组分别为（8．7±2．9）、（10．0±3．2）、（14．5±3．8）min，处于中间。结论 低浓度丙泊酚TCI（2μg／ml）复合雷米芬太尼用于妇科腹腔镜诊疗手术，可使患者术后清醒快，恢复迅速。
Objective To compare emergence time and rapid extubation after propofol anesthesia combined with remifentanil or nitrous oxide in patients undergoing elective gynecological laparoscopy. Methods Forty-five ASA I female patients with infertility were randomly allocated to three groups with 15 cases each. In group A（propofol TCI concentration 3 μg/ml）, propofol target concentration was kept at 3μg/ml. Remifentanil was infused at the rate of 0-1 μg · kg^-1 · min^-1 based on hemodynamic changes. In group B（propofol TCI concentration 2μg/ml）, propofol target concentration was kept at 2 μg/ml and remifentanil infusion rate was same to group A. In group C, After propofol TCI induction, nitrous oxide was added to maintain anesthesia. The end tidal nitrous oxide concentration was kept at （65±1）% ,and propofol target concentration was adjusted to obtain normal hemodynamics. At the end of operation, all anesthetics were discontinued at occasion of so called ＂zero point＂. Duration of opening eyes on verbal command, extubation time were recorded, together with time to recovery of awareness and orientation. Results There were highly significantly statistical differences in the three parameters recorded among all groups. Patients in group B had the shortest time of opening eyes（4.5±2. 1） min,extubation（5.4±2. 3） min,and recovery of awareness and orientation（8. 1± 2.8） min. Patients in group C had the longest emergence of（ 11.6 ± 3.4）, （12.7 ± 3.6 ）, （20.2 ± 4. 5） min respectively. Patients in group A were in the between with emergence time of （11.6± 3.4）, （12.7±3.6）, （20.2 ±4. 5） min respectively. Conclusion Low concentration of propofol target infusion （2 μg/ml） combined with remifentanil could provide rapid emergence from such an anesthesia after gynecological laparoscopy.
出处
《临床麻醉学杂志》
CAS
CSCD
2006年第10期755-757,共3页
Journal of Clinical Anesthesiology
关键词
丙泊酚
雷米芬太尼
氧化亚氮
麻醉苏醒
Propofol Remifentanil
Nitrous oxide Anesthesia emergence
