2020 年第 3 期 第 15 卷

丙泊酚复合瑞芬太尼在老年腹腔镜胆囊切除术中的麻醉效果

Anesthesia effect of propofol combined with remifentanil on laparoscopic cholecystectomy in elderly patients

作者：童华1李爽1郑少华1李欣1刘建新2

英文作者：

单位：1西安交通大学第一附属医院麻醉科710061；2西安交通大学医学部基础医学院神经生物学研究所710061

英文单位：

关键词：腹腔镜胆囊切除术；丙泊酚；瑞芬太尼；七氟烷

英文关键词：

• 摘要：

• 【摘要】目的    探讨七氟烷复合瑞芬太尼与丙泊酚复合瑞芬太尼麻醉对老年腹腔镜胆囊切除术患者血流动力学的影响及麻醉效果。方法    选取2018年1—12月于西安交通大学第一附属医院行腹腔镜胆囊切除术治疗的老年患者156例，应用随机数字表法分为对照组和观察组，各78例。对照组在常规麻醉基础上使用七氟烷复合瑞芬太尼麻醉,观察组在常规麻醉基础上使用丙泊酚复合瑞芬太尼麻醉。比较2组患者麻醉期间血流动力学变化情况（诱导前、插管时和拔管时收缩压、舒张压和心率）、术后恢复情况（呼之睁眼时间、恢复膝跳反射时间和拔管时间）、手术前后认知情况和患者意识［简易精神状态检查量表（MMSE）评分、观察者警觉镇静量表（OAA/S）评分］、苏醒期躁动情况和焦虑程度（Ramsay镇静评分、Riker镇静和躁动评分）和麻醉用药满意度。结果    观察组插管时和拔管时收缩压、舒张压和心率均低于对照组,术后呼之睁眼时间、恢复膝跳反射时间、拔管时间均早于对照组［(5.3±2.3)min比（11.4±4.2）min、(6.3±2.7)min比（10.5±5.3）min、(7±5)min比（14±4）min］,术后6 h MMSE量表评分高于对照组［(29.5±3.6)分比（23.5±3.7）分］，喉罩拔除后1、3 min时OAA/S评分高于对照组［(4.6±0.8)分比（3.8±0.6）分、(4.8±0.5)分比（3.7±0.6）分］，苏醒时和苏醒后30 min的Riker镇静躁动评分低于对照组、Ramsay镇静评分高于对照组,麻醉用药的满意度高于对照组［92.3%(72/78)比75.6%（59/78）］,差异均有统计学意义（均P＜0.05）。结论    在老年患者腹腔镜胆囊切除术中给予丙泊酚复合瑞芬太尼麻醉，能够较好地维持患者血流动力学稳定性及镇静效果，患者苏醒时间更短，恢复情况及麻醉感觉更为良好。

  
  

• 【Abstract】Objective    To analyze the effect of sevoflurane or propofol combined with remifentanil anesthesia on elderly patients undergoing laparoscopic cholecystectomy(LC) and the influence on hemodynamics. Methods    One hundred and fifty-six elderly patients undergoing LC in the First Affiliated Hospital of Xi′an Jiaotong University from January to December 2018 were randomly divided into observation group and control group, with 78 cases in each group. The control group had sevoflurane plus remifentanil and the observation group had propofol plus remifentanil on the basis of conventional anesthesia regimen. Hemodynamic changes(systolic blood pressure, diastolic blood pressure and heart rate) were observed before induction, during intubation and during extubation. Postoperative recovery(eye opening, knee reflex recovery and extubation time), patient cognition and awareness［Mini-Mental State Examination(MMSE) and Observer′s Assessment of Alertness/Sedation Scale(OAA/S)］, agitation and anxiety during wakening(Ramsay sedation score and Riker sedation agitation score) and anesthesia satisfaction were analyzed. Results    Systolic blood pressure, diastolic blood pressure and heart rate during intubation and extubation in the observation group were lower than those in the control group; eye opening time, knee reflex recovery time and extubation time in the observation group were shorter than those in the control group［(5.3±2.3)min vs (11.4±4.2)min, (6.3±2.7)min vs (10.5±5.3)min, (7±5)min vs (14±4)min］; MMSE score at 6 h after operation in the observation group was higher than that in the control group［(29.5±3.6) vs (23.5±3.7)］; OAA/S score at 1 and 3 min after removal of laryngeal mask in the observation group were higher than those in the control group［(4.6±0.8) vs (3.8±0.6), (4.8±0.5) vs (3.7±0.6)］; Riker sedation agitation score was lower and Ramsay sedation score was higher in the observation group than those in the control group at wakening and 30 min after wakening; anesthesia satisfaction rate in the observation group was higher than that in the control group［92.3%(72/78) vs 75.6%(59/78)］; the differences were statistically significant(P<0.05). Conclusion    Application of propofol combined with remifentanil in elderly patients undergoing LC can help maintain hemodynamic stability and sedative effect, shorten postoperative recovery and provide comfortable anesthesia.