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目的探究瑞芬太尼复合丙泊酚靶控输注在妇科腹腔镜手术中应用的临床效果。方法将2010年4月-2011年3月我院接收的40例妇科腹腔镜手术患者,随机分为两组:采用瑞芬太尼复合丙泊酚靶输注的20例患者作为观察组;对照组20例患者采用持续输注丙泊酚辅助吸入异氟烷的方法来维持麻醉。在手术的过程中注意根据实际的情况调整丙泊酚靶控输注的速度以及芬太尼的使用量。记录有关手术过程中的循环变化,以及术后的康复状况。观察两组患者手术麻醉前、进行气腹后即刻、实施插管后即刻、以及手术后的MAP(平均动脉压)、HR(心率)、Glu和AAI,观察和记录患者在接受麻醉前以及气腹后30分钟的Co和NE浓度。结果两组(观察组和对照组)患者各个时刻内的AAI值没有明显的统计学差异(P>0.05)。气腹后以及插管即刻观察组平均动脉压、心率等指标都明显低于对照组(P<0.05)。观察组Co、NE的浓度,明显低于对照组(P<0.01)。Glu在手术完毕后观察组明显的低于对照组(P<0.01)。结论以瑞芬太尼复合丙泊酚靶控输注为主的静脉手术麻醉与辅助异氟醚吸入同时结合芬太尼为主的麻醉方法相比在妇科腹腔镜手术中更能有效地抑制一些应激性反应,提高手术的质量。
Objective To investigate the clinical effect of remifentanil combined with propofol target controlled infusion in gynecological laparoscopic surgery. Methods From April 2010 to March 2011, 40 patients undergoing gynecological laparoscopic surgery in our hospital were randomly divided into two groups: 20 patients receiving remifentanil combined with propofol target infusion as the observation group; the control group Group of 20 patients with continuous infusion of propofol assisted inhalation of isoflurane method to maintain anesthesia. During the operation, pay attention to adjust the rate of target-controlled infusion of propofol and the dosage of fentanyl according to the actual situation. Record changes in the cycle of surgery, and postoperative rehabilitation. The patients were anesthetized before surgery, immediately after pneumoperitoneum, immediately after intubation, and MAP (mean arterial pressure), HR (heart rate), Glu and AAI after surgery. The patients before and after anesthesia were observed and recorded Co and NE concentrations 30 minutes after abdomen. Results There was no significant difference in AAI between two groups (observation group and control group) at each time point (P> 0.05). After pneumoperitoneum and intubation immediately observed the mean arterial pressure, heart rate and other indicators were significantly lower than the control group (P <0.05). The concentrations of Co and NE in the observation group were significantly lower than those in the control group (P <0.01). Glu after the operation was significantly lower in observation group than in the control group (P <0.01). Conclusion Intravenous anesthesia with remifentanil combined with propofol target controlled infusion is more effective than gynecological laparoscopic surgery in anesthesia with adjuvant isoflurane inhalation combined with fentanyl-based anesthesia Stress reaction, improve the quality of surgery.