目的:观察瑞芬太尼-丙泊酚靶控输注全麻下腹腔镜胆囊切除术中的血流动力学变化.方法:18例择期腹腔镜胆囊切除术患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ-Ⅱ级,入室后即行外周动脉心排量监测,以瑞芬太尼-丙泊酚靶控输注复合芬太尼诱导并维持麻醉至手术结束.分别记录手术期间10个时点的心率(HR),平均动脉压(MAP),收缩压(SBP),舒张压(DBP)和外周动脉心功能指数(APCI).结果:气腹建立后即刻HR增快,DBP升高,APCI明显下降(P＜0.05),5 min后,DBP进一步升高(P＜0.05),SBP、MAP及APCI逐步恢复至气腹前水平且保持相对稳定.气腹解除后即刻HR减慢、DBP降低和APCI升高(P＜0.05)；5 min后MAP、DBP下降(P＜0.05),但仍较气腹前高,而HR及APCI恢复气腹前水平.结论:瑞芬太尼-丙泊酚靶控输注全麻下腹腔镜胆囊切除术中,除气腹建立及解除短时间内血流动力学变化较明显外,术中整体血流动力学维持平稳.%Objective;To observe the hemodynamic changes during remifentanil-propofol anesthesia for laparoscopic cholecys-tectomy. Methods:Eighteen patients (ASA I-II) scheduled for laparoscopic cholecystectomy were included in this study. After entering operation room,patients were monitored by arterial pressure-based cardiac output measurement device. Patients were induced and maintained anesthesia with remifentanil-propofol target controlled infusion system. Heart rate (HR),mean arterial pressure (MAP),systolic blood pressure (SBP),diastolic blood pressure(DBP) and arterial pressure-based cardiac index (AP-CI) were recorded at 10 different time points during the surgery. Results: After CO2 insufflation,HR and DBP increased,AP-CI decreased (P<0. 05). 5 minutes later,DBP increased further,SBP,MAP and APCI recovered to previous level gradually and kept stable. After exsufflation,HR and DBP decreased,APCI increased (P<0. 05). After pneumoperitoneum was removed 5 minutes,MAP and DBP decreased (P<0. 05),but they were still higher than the levels before peritoneal insufflation. HR and APCI returned to the levels before peritoneal insufflation. Conclusion; During the process of remifentanil-propofol anesthesia for laparoscopic cholecystectomy,the hemodynamic parameters keep stable,except during the short time after peritoneal insufflation and exsufflation.
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