摘要
目的探讨靶控输注瑞芬太尼对腹腔镜手术患者围术期应激反应的影响。方法将30例择期妇科腹腔镜卵巢肿瘤切除术患者随机分为对照组(A组,n=15)和瑞芬太尼组(B组,n=15)。常规全麻诱导,两组术中均采用吸入1.5%～2.0%异氟烷维持麻醉。B组于气腹前据血压术中持续泵入瑞芬太尼0.10～0.25μg/(kg.min),维持瑞芬太尼血浆靶浓度5μg/L,麻醉维持期在2.0～4.0μg/L之间,手术结束前1 min停用瑞芬太尼,其余处理两组完全相同。记录A组与B组患者气腹前(T1)、气腹5 min(T2)、30 min(T3)及放气后10 min(T4)、拔管后(T5)的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)的改变,同时测定T1、T2、T3和T4血中去甲肾上腺素(NE)、肾上腺素(E)和多巴胺(DA)的浓度。结果 B组各时点上述指标与T1相比无明显改变。A组气腹期间各时点的SBP、DBP、MAP与T1相比明显升高(P<0.05);各时点血液中NE、E、DA与T1相比明显增高(P<0.05)。结论腹腔镜全麻手术辅助应用瑞芬太尼能有效减轻气腹引起的血流动力学变化,适度抑制腹腔镜手术中的应激反应,维持内环境稳定。
Objective To explore the effect of target-controlled infusion of Remifentanil for the laparoscopic surgery perioperative stress response.Methods 30 patients undergoing elective gynecological laparoscopy were randomly divided into control group（group A,n = 15） and Remifentanil group（group B,n = 15）.Routine anesthesia induction,the two groups of patients were using inhaled 1.5%-2.0% Isoflurane to maintain anesthesia.Group B received Remifentanil continous infusion by velocity of 0.10-0.25 μg/（kg·min）,maintained a Remifentanil target plasma concentration of 5 μg/L,the maintenance phase of anesthesia was between 2.0-4.0 μg/L,1 min before the end of surgery to stop Remifentanil,the rest was the same.Before pneumoperitoneum,the changes of HR,SBP,DBP,MAP at T1（before pneumoperitoneum）,T2（after pneumoperitoneum for 5 min）,T3（after pneumoperitoneum for 30 min）,T4（deflation for 10 min）,T5（after decannulation） were recorded;NE,E and DA concentration in T1-T4 were detected.Results All parameters had no significant changes in group B at different time compared with T1.In group A,SBP,DBP,MAP in T2-T5 were increased significantly against T1（P 〈 0.05）,NE,E,DA in T2,T3,T4 were increased significantly against T1（P 〈 0.05）.Conclusion Laparoscopic surgery under general anesthesia combined with Remifentanil can effectively reduce the hemodynamic changes caused by pneumoperitoneum,suppress the stress response in laparoscopic surgery,maintain homeostasis
出处
《中国医药导报》
CAS
2012年第7期76-77,共2页
China Medical Herald
关键词
瑞芬太尼
应激
CO2气腹
Remifentanil
Stress
CO2 pneumoperitoneum
