Effects of different anesthetic techniques on circulation,stress response and postoperative recovery in patients undergoing leparoscopic cholecystectomy

TIAN Lu; et al

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Effects of different anesthetic techniques on circulation,stress response and postoperative recovery in patients undergoing leparoscopic cholecystectomy

更新时间：2024-01-17

- Effects of different anesthetic techniques on circulation,stress response and postoperative recovery in patients undergoing leparoscopic cholecystectomy
- Journal of Chongqing Medical University Vol. 34, Issue 11, Pages: 1571-1573(2009)
- 作者机构：
  
  重庆医科大学第一附属医院麻醉科
- 作者简介：
- 基金信息：
- DOI：
  CLC： R614
- Published：2009，
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[1]田璐,刘新伟,闵苏,朱儒红,陈星菊.不同麻醉方法腹腔镜胆囊切除术对循环应激反应术后恢复的影响[J].重庆医科大学学报,2009,34(11):1571-1573.

TIAN Lu, et al. Effects of different anesthetic techniques on circulation,stress response and postoperative recovery in patients undergoing leparoscopic cholecystectomy. [J]. Journal of Chongqing Medical University 34(11):1571-1573(2009)
[1]田璐,刘新伟,闵苏,朱儒红,陈星菊.不同麻醉方法腹腔镜胆囊切除术对循环应激反应术后恢复的影响[J].重庆医科大学学报,2009,34(11):1571-1573. DOI：

TIAN Lu, et al. Effects of different anesthetic techniques on circulation,stress response and postoperative recovery in patients undergoing leparoscopic cholecystectomy. [J]. Journal of Chongqing Medical University 34(11):1571-1573(2009) DOI：

摘要

目的:比较3种不同麻醉方法用于腹腔镜胆囊切除术（Laparoscopic cholecystectomy

LC）对病人围麻醉期循环应激反应及术后恢复的影响。方法:66例年龄18～60岁

ASAⅠ～Ⅱ级择期行LC手术病人（n=66）

随机分为3组（n=22）

瑞芬太尼+七氟烷组（Ⅰ组）

芬太尼+异氟烷+丙泊酚组（Ⅱ组）

瑞芬太尼+丙泊酚TCI组（Ⅲ组）。观察围麻醉期平均动脉压（Mean arterical pressure

MAP）、心率（Heart rate

HR）、血清白介素-6（IL-6）、皮质醇以及血糖浓度的变化与麻醉恢复期各组病人麻醉后恢复时间、Aldrete评分≥9分的时间、术后恶心呕吐发生率以及用视觉模拟评分（Visual analogue scales

VAS）评定术后疼痛。结果:Ⅰ、Ⅱ组插管前MAP下降显著（P<0.01）

Ⅲ组在气腹建立1min后MAP上升显著（P<0.01）。各组血糖

皮质醇水平在手术结束时均显著高于诱导前（P<0.01）。Ⅰ、Ⅲ组IL-6在手术结束时显著增加（P<0.01）。麻醉恢复期Ⅱ组拔管时间、清醒时间、Aldrete评分≥9分时间较Ⅰ、Ⅲ组显著延长（P<0.05）。术后VAS评分

各组比较差异无统计学意义（P>0.05）。术后恶心呕吐各组发生率差异无统计学意义（P>0.05）。结论:3种麻醉方法均适用于LC手术

但用瑞芬太尼+七氟烷或瑞芬太尼+丙泊酚TCI维持麻醉更具恢复时间短、质量高的优点;LC手术可导致机体明显应激反应

术后疼痛明显

恶心呕吐发生率高

应予积极处理。

Abstract

Objective:To investigate the effects of three different anesthetic techniques on pere-anesthesia circulation

stree response and post-anesthesia recovery in patients undergoing leparoscopic cholecystectomy(LC).Methods:Sixty-six ASA Ⅰ or Ⅱ patients aged 18 to 60 undergoing selected LC surgery were randomly divied into 3 groups(n=22).The patients in group I were induced and maintained with remifentanil and sevoflurane.The patients in group Ⅱ with fentanil

propofol and isoflurane

while the patients in group Ⅲ with remifentanil and propofol TCI.MAP and HR were measured before induction

before intubation

at 5 min after intubation

1 min and 15 min after the establishmen of CO2 pneumoperitoneum and at the end of operation.Blood cortisol(Cor)and blood glucose(Glu)were measured before induction

after induction 5 min and at the end of operation;Blood interleukin-6(IL-6)was measured before induction and at the end of operation.Postoperative recovery time

Alddret ≥9

the rate of PONV and VAS score were measured on the first postoperative day.Results:There were significant decreases of MAP in group Ⅰ and Ⅱ before intubation(P<0.01).MAP in group Ⅲ increased significantly 1 min after CO2 pneumoperitoneum was established.Blood IL-6 of Group Ⅰ and Ⅲsignificantly increased at the end of operation(P<0.01).Cor and Glu of all three groups were significantly increased at the end of operation compared with those before induction(P<0.01).In anesthesia recovery duration

the times for extubation

recovery and the Aldrete≥9 score were significantly shorter in group Ⅰ and group Ⅲ compared with group Ⅱ(P<0.01).The rate ofPONV and VAS score after operation had no significant differences between either two of the three groups(P > 0.05).Conclusion:The three anesthetic techniques can be used safely on LC operation

anesthesia with remifentanil and sevoflurane

anesthesia with remifentanil and propofol TCI have shorter post-operative recovery time and high quality compared with the anesthesia with fentanil

isoflurane and propofol.LC operation can cause obvious stress response of the body

significant postoperative pain and high rate of PONV

which should be actively dealt with.

关键词

腹腔镜手术瑞芬太尼七氟烷应激反应苏醒时间

Keywords

LaparoscopyremifentanilsevofluraneStress resp onseRecovery time

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Department of Anesthesiology,the First Affiliated Hospital,Chongqing Medical University

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重庆医科大学附属第一医院麻醉科

Department of Anesthesiology,the First Affiliated Hospotial,Chongqing Medical University

Department of Anesthesia,the First Affiliated Hospital,Chongqing Medical University

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