摘要
目的对行妇科腹腔镜手术的不同年龄的患者采用瑞芬太尼、丙泊酚靶控输注进行诱导和维持,观察此麻醉方式的临床疗效。方法60名ASAⅠ～Ⅲ级、行择期妇科腹腔镜手术的患者,分为Ⅰ组(<65岁)和Ⅱ组(≥65岁),每组30例。麻醉诱导,Ⅰ组瑞芬太尼靶效应室浓度4 ng/ml,Ⅱ组瑞芬太尼靶浓度2.5 ng/ml,2组丙泊酚血浆靶浓度从2.0μg/ml逐渐升高至意识消失,气管插管后根据脑电双频指数(BIS)和血流动力学参数变化调整丙泊酚和瑞芬太尼的靶浓度。记录患者诱导和维持阶段丙泊酚和瑞芬太尼靶浓度、收缩压(SBP)、舒张压(DBP)、心率(HR)及苏醒时间。结果Ⅱ组患者意识消失时丙泊酚靶血药浓度明显低于Ⅰ组[(2.5±0.4)μg/ml vs(3.2±0.5)μg/ml,t=5.988,P=0.000],维持过程中Ⅱ组平均丙泊酚靶浓度低于Ⅰ组[(2.1±0.5)μg/ml vs(2.7±0.7)μg/ml,t=3.820,P=0.000],维持过程中Ⅱ组瑞芬太尼靶浓度明显低于Ⅰ组[(0.19±0.06)ng/ml vs(0.32±0.06)ng/ml,t=8.391,P=0.000]。2组诱导后SBP明显下降,气管插管后回升,术中维持稳定。2组DBP、HR的波动无统计学意义。2组血管活性药的应用例数差异无显著性。Ⅱ组麻醉恢复时间长于Ⅰ组(P<0.05)。结论根据监测数据个体化地调整丙泊酚和瑞芬太尼的靶浓度,能够使行妇科腹腔镜手术老年患者的血流动力学波动范围和麻醉深度维持在与中青年近似的水平,但老年患者苏醒时间仍延长。
Objective To evaluate the efficacy of target controlled infusion （TCI） of remifentanil and propofol in patients at different ages undergoing gynecologic laparoscopic surgery. Methods A total of 60 patients （ ASA Ⅰ - Ⅲ ） undergoing elective gynecologic laparoscopic surgery were divided into two groups according to their age （ Group Ⅰ ： 〈 65 years, and Group Ⅱ： ≥ 65 years）. All the patients received TCI of remifentanil and propofol. The initial target effect-site concentration of remifentanil was 4 ng/ml for Group Ⅰ and 2.5 ng/ml for Group Ⅱ. The target plasma concentration of propofol was 2.0 μg/ml initially for both the groups, and then increased by steps of 0.5μg/ml until the loss of consciousness. The target concentrations of remifentanil were adapted to intraoperative hemodynamics and target plasma concentrations of propofol were titrated to maintain BIS values between 40 and 60 throughout the intraoperative period. During which hemodynamic variables were recorded, the average target concentrations of remifentanil and propofol were assessed, number of hemodynamie events and the use of vasoaetive drugs were collected, and the recovery time was recorded in all of the patients. Results The propofol target concentration at time of consciousness loss in Group Ⅱ was significantly lower than that in Group Ⅰ i（2.5±0.4）μg/ml vs （3.2±0.5） μg/ml, t=5.988, P=0.000]. While the target concentrations of propofol and remifentanil during maintenance in Group Ⅱ were lower than those in Group Ⅰ [ propofol ： （2.1 ±0.5） /μg/mlvs （2.7 ±0.7） μg/ml, t =3.820, P=0.000; remifentanil： （0.19±0.06） ng/ml vs （0.32±0.06） ng/ml, t=8.391, P= 0. 000]. Systemic blood pressure t SBP） decreased significantly in both the groups after induction and then increased after intubation and remained stable during surgery. The SBP changed in a similar pattern in the two groups. The changes of diastolic blood pressure and heart rate were not statistically different at various
出处
《中国微创外科杂志》
CSCD
2009年第2期116-119,共4页
Chinese Journal of Minimally Invasive Surgery
