【摘要】 目的探讨瑞芬太尼、异丙酚复合硬外麻醉对腹腔镜胆囊切除术后清醒质量的影响。方法选择全麻下行择期腹腔镜胆囊切除术患者30例,ASAI～II级,随机分为R组(瑞芬太尼组)和RE组(瑞芬太尼+硬外麻醉组),每组15例。记录麻醉前(T0)、术毕(T1)、达拔管指征时(T2)、拔管时(T3)、拔管后1min(T4)、拔管后5min(T5)、拔管后10min(T6)、拔管后20min(T7)八个时点的收缩压×心率(RPP);术毕患者呼吸恢复时间、苏醒时间、指令反应恢复时间、拔管时间;围拔管期副反应发生率;于拔管后30min以Ralnsay清醒评分法评定镇静程度;于拔管后5min、拔管后1h、拔管后3h和拔管后24h评定伤口疼痛程度。结果①与麻醉前相比,R组和RE组患者于达拔管指征时和拔管时的收缩压×心率均有所升高,且R组上升幅度大于RE组;与R组相比,RE组患者于拔管时、拔管后1min、拔管后5min、拔管后10min的收缩压×心率均明显降低,两组之间的差异有统计学意义;②呼吸恢复时间、苏醒时间、指令反应恢复时间、拔管时间RE组明显短于R组,两组之间的差异有统计学意义;③与R组相比,RE组患者躁动、寒战的发生率明显降低;④与R组相比,RE组Ramsay评分为1级的病例数明显减少;⑤与R组比较,RE组患者在拔管后5min、拔管后1h、拔管后3h、拔管后24h的VAS评分均明显降低,需要镇痛药物的病例数明显减少。结论瑞芬太尼、异丙酚复合硬外麻醉组能够为围拔管期提供更为平稳的血流动力学环境,减少术后疼痛、躁动的发生,明显缩短术后苏醒、拔管时间。更多还原

【Abstract】 Objective To compare the quality of recovery from epidural anesthesia combined with remifentanil and using remifentanil only in laparoscopic cholecystectomy.Methods Thirty ASAI～II patients of laparoscopic cholecystectomy were randomely divided into two groups of 15 patients:group R(remifentanil) and group RE(repidural anesthesia combined with remifentanil).The following were recorded and compared between group R and RE:① RPP at the following time:before anesthesia(T0),end of surgery(T1),reach the indication of tracheal extubation(T2),tracheal extubation(T3),1min after extubation(T4),5 rnin after extubation(T)5,10min after extubation(T6),20min after extubation(T7);②The duration from termination of surgery to full recovery of spontaneously breathing,eye opening,response to instruction and tracheal extubation;③ Postoperative complications like chill,cough,nausea and vomiting,low SP02,restlessness,lethargy;④ Ramsay score after operation;⑤ VAS score at the following time:5min after extubation,1 hour after extubation,3 hours after extubation and 24 hours after extubation.Results ①RPP at T2 and T3 in both groups were higher than those at T0;RPP at T3,T4,T5,T6 in group RE were lower than those in group R;②There were statistics difference of the duration from termination of surgery to full recovery of spontaneously breathing,eye opening,response to instruction and tracheal extubation between the two groups;③The incidence of postoperative restlessness and chill was lower in group RE than that in group R;④The patients of first grade of Ramsay score were fewer in group RE than in group R;⑤VAS scores at 5 min after extubation,1 hour after extubation,3 hours after extubation and 24 hours after extubation in group RE were significantly lower than those in group R and fewer patients needed analgesic.Conclusion Using epidural anesthesia combined with remifentanil is hemodynamically stable,and it can reduce postoperative pain and significantly reduce the time of awakening and tracheal extubation.更多还原