目的:探讨艾司洛尔对妇科腹腔镜手术中丙泊酚用量的影响.方法:40例美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级、择期行妇科腹腔镜手术患者,随机分为艾司洛尔组(E组)和对照组(C组),每组20例.E组麻醉诱导前15 min时,静脉注入艾司洛尔0.5 mg/kg,随后以50 μg/(kg·min)持续静脉输注直至手术结束;C组以等量的0.9%氯化钠液代替.采用芬太尼(3 μg/kg)、丙泊酚(Ce=3 μg/mL)及罗库溴铵 (0.8 mg/kg) 诱导插管,术中调整丙泊酚预期血浆浓度Cp值,使得脑双频指数(BIS)波动于40～55.分别记录手术期间丙泊酚用量和苏醒时间,以及麻醉诱导前15 min(艾司洛尔给药前,T0)、麻醉诱导前(T1)、插管前(T2)、插管后1 min(T3)、气腹后30 min(T4)、手术结束时(T5)、拔管后1 min(T6)各时点的收缩压(SBP)、心率(HR)和脑双频指数(BIS)值.结果:E组手术期间丙泊酚用量(78.4±11.2 μg/(kg·min)少于C组用量(89.3±15.2 μg/kg/min),P<0.05;E组苏醒时间(10.4±2.5 min)短于C组(12.1±2.7 min),P<0.05.插管后1 min(T3),C组SBP、HR和BIS均高于E组(P<0.05).而T4、T5、T6时点,C组HR均高于E组(P<0.05).结论:围术期小剂量艾司洛尔持续输注可减少妇科腹腔镜手术中丙泊酚的用量,且使麻醉诱导和苏醒平稳、迅速.%Objective:To investigate the effect of perioperative esmolol infusion on propofol requirement during gynecologic laparoscopic surgery.Methods: A total of 40 ASA status Ⅰ ～ Ⅱ patients (consisting two groups) undergoing gynecologic laparoscopic surgeries were enrolled in this prospective, randomized, study.At 15 min before anesthesia induction, the esmolol group(Group E,n = 20) received a loading dose of esmolol (0.5 mg/kg) followed by continuous infusion (50 μg/kg/min) until the end of surgery, while the control group(Group C, n = 20) received normal saline in the same manner.After induction with fentany(3 μg/kg), propofol (TCI, Ce = 3 μg/mL ) and rocuronium (0.8 mg/kg), tracheal intubations were completed by the same anesthesiologist in 60s.During the operation, the plasma concentration (Cp) of propofol was adjusted to maintain the value of BIS between 40 and 55.The intraoperative propofol requirement, recovery time and SBP, HR, BIS at 15 min before induction (T0), before induction (T1), before intubation (T2), 1 min after induction (T3), 30 min after pneumoperitoneum established (T4), end of surgery (T5) and 1 min after extubation (T6) were recorded respectively.Results: The intraopertive propofol requirement was less in Group E than that in Group C [78.4 ± 11.2 vs.89.3 ± 15.2 μg/(kg · min), P ＜0.05)], and the recovery time was shorter in Group E than that in Group C (10.4 ± 2.5min vs.12.1 ± 2.7 min, P ＜0.05).The values of systolic blood pressure(SBP), heart rate(HR) and bis pectral index(BIS) in Group C were higher compared with Group E ( P ＜0.05) at T3, while the values of HR in Group C were also higher at T4, T5 and T6 compared with Group E ( P ＜0.05).Conclusions: Perioperative esmolol infusion reduced the intraoperative propofol requirement and the recovery time in gynecologic laparoscopic surgery, and decreased the hemodynamic response to tracheal intubation.
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