【摘要】 目的观察静脉快通道麻醉在腹腔镜胆囊切除手术中的应用,并比较静脉麻醉和吸入麻醉对病人麻醉恢复的影响。方法选择100例ASA体格状况为I、II级,在腹腔镜下行择期单纯胆囊切除手术的病人,随机等分成两组。实验组(静脉全麻组):麻醉诱导采用咪唑安定0.04mg/kg,瑞米芬太尼2μg/kg,异丙酚2mg/kg,阿曲库铵0.6mg/kg诱导后气管插管;麻醉维持采用瑞米芬太尼0.1μg/(kg·min)、异丙酚80～120μg/(kg·min)、阿曲库铵8～10μg/(kg·min)全部采用微泵注射。对照组(吸入麻醉组)麻醉诱导同实验组,麻醉维持采用安氟醚,阿曲库铵8～10μg/(kg·min)微泵注射。两组病人的麻醉深度维持在心率、血压于术前±20%。手术结束后采用Steward评分方法,10min内评分在4分及以上者送回病房,否则送入ICU;记录两组病人术后恶心呕吐的发生情况及其他并发症。结果两组病人手术时间和麻醉时间无明显差异;实验组10min内评分在4分及以上者有43人,对照组为31人,两组相比,P<0.05;实验组术后恶心呕吐12例,对照组27例,P<0.01。结论静脉快通道麻醉可让腹腔镜胆囊切除术病人术后尽早苏醒,降低恶心呕吐发生率,并减少进入PACU或ICU机会。更多还原

【Abstract】 Objective To investigate the effect of intravenous fast-tracking anesthesia on recovery in patients undergoing laparoscopic cholecystectomy and compare it with inhaled anesthesia. Methods 100 patients, ASA physical status I~II, were randomly divided into two groups. All patients were induced with midazolam 0.04 mg/kg, remifentanil 2 μg/kg, propofol 2 mg/kg and atracurium 0.6 mg/kg intravenously. Anesthesia was maintained with propofol 80~120 μg/(kg·min), remifentanil 0.1~0.2 μg/(kg·min) and atracurium 8~10 μg/(kg·min) intravenously via pump in intravenous anesthesia group (TIVA group) and maintained with enflurane, atracurium 8~10 μg/(kg·min) intravenously via pump in inhaled anesthesia group(control group). Anesthesia depth was maintained to keep NIBP and HR within±20% of preoperative values. The patients were scored using Steward postanesthesia recovery score system after operation completed. Patients with scores of 4 or higher within 10min were transferred to the ward, otherwise recovered in ICU until they met the above discharge criteria and were transferred to the ward. Post operative nausea and vomiting (PONV) and other postoperative complications were recorded. Results 43 patients scored 4 or higher within 10 min in TIVA group were transferred to the ward, but 31 in control group, P <0.05. Incidence of PONV was 24%(12) in TIVA group, but 54%(27) in control group, P <0.01. Conclusion Intravenous fast-tracking anesthesia in laparoscopic cholecystectomy could get a rapid recovery and reduce the incidence of PONV.更多还原