靶控输注异丙酚与吸入异氟醚麻醉在腹腔镜胆囊切除术中的效果_论文.docxVIP

靶控输注异丙酚与吸入异氟醚麻醉在腹腔镜胆囊切除术中的效果 【摘要】 目的 比较靶控输注异丙酚（target-controllde infusion，TCI）全凭静脉麻醉和异氟醚吸入麻醉两种不同方式在腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）应用中的临床效果。方法 将30例择期行LC手术的患者随机分为两组。TCI 组（T组）（n=15）：设定诱导时靶浓度为4μg/ml，术中维持异丙酚靶浓度为3～μg/ml。异氟醚组（I组）（n=15）：采用3%异氟醚吸入诱导、1%～%维持。术中监测心率（heart rate，HR）、收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure， DBP）、平均动脉压（mean arterial pressure，MAP）等指标。结果 T 组诱导时间显著短于I组（P＜），术中T组生命体征维持相对平稳，术后苏醒T组明显优于I组。结论 TCI全凭静脉麻醉方法用于LC 术，术中血流动力学稳定，术后患者苏醒迅速，明显优于异氟醚吸入麻醉方法。 【关键词】 胆囊切除术 腹腔镜 靶控输注 异丙酚 异氟醚 Comparsion of anesthesia maintained by propofol target-controlled 【Abstract】 Objective To study the benefit of propofol with target-controlled infusion(TCI)for laparoscopic cholecystectomy(LC) in comparison with isoflurane inhalation.Methods Thirty patients scheduled for LC were randomized to two groups：propofol group(T-group)(n=15).The patients in T-group werre given TCI with the target concentration 4 μg/ml during induction and 3～ μg/ml during %isoflurane during induction and 1%～% during maintenance were inhaled in I-group. SBP， DBP and HR were monitored continuously in two groups during operation.Results The time of induction in T-group was shorter than that in I-group(P＜).The vital signs were stable in T-group during operation. The patients in T-group gained more comfortable recovery than those in I-group.Conclusion During the anesthesia of propofol TCI for LC the hemodynamics is more stable than that of isoflurane inhalation，and the recovery is the anesthesia maintained by propofol target controlled infusion for laparoscopy cholecystectomy is better than that by isoflurane inhalation. 【Key words】 cholecystectomy laparoscopic target-controlled infusion propofol isoflurane 腹腔镜胆囊切除术已在临床广泛开展。因CO2气腹会导致腹腔内压力增高，膈肌上抬，从而使胸腔内的压力也明显增高，最终影响患者的血流动力学，所以临床中通常首选气管插管全身麻醉。LC术手术时间较短，要求患者迅速达到一定的麻醉深度，同时又能快速清醒。靶控输注(target-controlled infusion，TCI)是一种新的静脉麻醉方法，是根据药代动力学三室模型以血浆浓度或效应室浓度来反馈控制的计算机输注系统。本研究通过比较靶控维持与传统的吸入维持麻醉对术中血流动力学的影响，探讨TCI麻醉方法的优越性。