舒芬太尼在老年腹腔镜胆囊切除术中的应用

目的：探讨舒芬太尼在老年患者腹腔镜胆囊切除术中的麻醉效果。方法：180例接受腹腔镜胆囊切除术的老年患者随机分为3组：芬太尼组（F组芬太尼用量20μg/kg）,舒芬太尼1组（S1组舒芬太尼用量为0.5μg/kg）,舒芬太尼2组（S2组舒芬太尼用量为1μg/kg）。比较3组患者镇静后10 min时、麻醉诱导即时、气管插管后3 min、二氧化碳气腹、二氧化碳气腹15 min、手术结束时的SBP、DBP。推算MBP、HR、ECG、SpO2。观察患者手术结束时到自主呼吸恢复时间、初醒时间,气导管拔出的时间及拔管时患者SBP、DBP。推算MBP、HR、ECG、SpO2和并发症发生情况。结果：S1组和S2组两组患者在气管插管,二氧化碳气腹前后血流动力学波动较小,而F组患者的波动相对较大。S1,S2组间比较,差异无统计学意义;S1组与F组比较自主呼吸恢复时间、苏醒时间、气导管拔出的时间,差异无统计学意义。拔管时患者SBP、DBP、MBP、HR,S1组血流动力学更加平稳,且术后并发症明显减少,与F组比较,差异有统计学意义;但S2组自主呼吸恢复时间明显延长,部分患者需要加用阿片类药物拮抗药,使用拮抗药后部分患者有烦躁、不自主体动等并发症,与其他两组比较,差异有统计学意义。结论：老年患者腹腔镜胆囊切除术采用舒芬太尼0.5μg/kg,能良好的控制因气管插管,二氧化碳气腹导致的应急反应,维护血流动力学的平稳,同时不影响患者术后的苏醒。

Application of Sufentanil in Laparoscopic Cholecystectomy on the Elderly

Objective：To explore the anesthetic effect of sufentanil on elderly patients with laparoscopic cholecystectomy. Methods：One hundred and eighty elderly patients undergoing laparoscopic cholecystectomy were randomly divided into 3 groups： group F（fentanyl with dosage of 20 μg/kg）,group S1（sufentanil with dosage of 0.5 μg/kg）and group S2（sufentanil with dosage of 1μg/kg）. Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean blood pressure（MBP）,heart rate（HR）, electrocardiogram（ECG） and pulse oxygen saturation（SpO2）at 6 time points（Respectively,10 minutes after sedation,instant of anesthesia induction,3 minsutes after endotracheal intubation,instant of carbon dioxide pneumoperitoneum,15 minutes after carbon dioxide pneumoperitoneum and postoperative）were recorded and examined. The breathing recovery time,early wake up time and the time of air duct removal,the hemodynamic parameters of extubation,as well as the complications in 3 groups were compared. Results：Compared with group F,hemodynamics fluctuated more slightly in endotracheal intubation and around carbon dioxide pneumoperitoneum in group S1 and S2,without significant difference between S1 and S2. There was no differences in the breathing recovery time,the early wake up time and the time of air duct removal between group S1 and F. Compared with group F, hemodynamics were more stable and with less complications at air duct removal in group S1. However,spontaneous breathing recovery time extended obviously in group S2,and some patients in group S2 required additional opioid antagonist medicine which brought fret and involuntary physical activity. Conclusion：Application of 0.5 μg/kg sufentanil in laparoscopic cholecystectomy in elderly patients could reduce the emergency responses induced by endotracheal intubation and CO2pneumoperitoneum,maintain stable hemodynamics and would not affect the postoperative palinesthesia.