摘要目的 评价妇科腹腔镜手术患者气腹不同阶段伤害性刺激强度的变化.方法 拟行妇科腹腔镜手术患者45例,年龄25～36岁,ASA分级Ⅰ或Ⅱ级,体重指数18～23 kg/m2,采用随机数字表法,将患者随机分为3组(n=15):Ⅰ组采用全凭静脉麻醉,靶控输注瑞芬太尼(血浆靶浓度4～6ng/ml)和异丙酚(血浆靶浓度2 μg/ml)维持麻醉,根据BP和HR变化调整药物浓度,维持血液动力学平稳.Ⅱ组和Ⅲ组均吸入异氟醚(呼气末浓度1%～2%),靶控输注瑞芬太尼(血浆靶浓度2～4 ng/ml),两组分别于气腹前5 min、腹腔快速充气结束后5 min时停用瑞芬太尼,吸入异氟醚(呼气末浓度1%～2%)维持麻醉至手术结束.分别于麻醉前(T0)、气腹前5 min(T1)、气腹5 min(T2)和气腹15 min(T3)时监测HR和MAP,抽取肘静脉血,测定血浆皮质醇(Cor)、去甲肾上腺素(NE)和肾上腺素(E)的浓度.结果 与T0时比较,Ⅱ组T2,3时HR和MAP、血浆NE和E浓度、T3时cor浓度升高(P<0.05);与Ⅰ组比较,Ⅱ组T2,3时HR和MAP、血浆NE和E浓度、T3时Cor浓度升高(P<0.05);与Ⅱ组比较,Ⅲ组T2,3时HR和MAP、血浆NE和E浓度、T3时Cor浓度降低(P<0.05).结论 妇科腹腔镜术患者气腹不同阶段中,腹腔快速充气阶段的伤害性刺激最强,应注意调控麻醉深度.

abstractsObjective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in gynecological laparoscopic surgery. Methods Forty-five ASA Ⅰ orⅡ patients, aged 25-36 yr, with body mass index 18-23 kg/m2 , undergoing elective gynecological laparoscopic surgery, were randomly divided into 3 groups ( n = 15 each) . In group Ⅰ , anesthesia was maintained with TCI of remifentanil (target plasma concentration 4-6 ng/ml) and propofol (target plasma concentration 2 μg/ml) , and the concentrations were ad-justed according to the changes in BP and HR to maintain hemodynamics stable. Ⅱ and Ⅲ groups received inhala-tion of isoflurane (end-tidal concentration 1%-2%) and TCI of remifentanil (target plasma concentration 2-4ng/ml) . TCI of remifentanil was then stopped at 5 min before pneumoperitoneum (group Ⅱ ) or at 5 min after theend of rapid inflation (group Ⅲ ) , and isoflurane was inhaled (end-tidal concentration 1%-2% ) to maintain anes-thesia until the end of operation in Ⅱ and Ⅲ group. Before anesthesia (T0 ), 5 min before pneumoperitoneum (T1), 5 and 15 min of pneumoperitoneum (T2,3), HR and MAP were monitored and venous blood samples were taken for determination of plasma cortisol (Cor) , norepinephrine ( NE) and epinephrine ( E) concentrations. Results HR, MAP and NE and E concentrations at T2,3 , and Cor concentrations at T3 were significantly higher than those at T0 ingroup Ⅱ , and in group Ⅱ than in group Ⅰ (P<0.05). HR, MAP and NE and E concentrations at T2,3 ,and Cur concentrations at T3 were significantly lower in group Ⅲ than in group Ⅱ ( P < 0.05). Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in gynecological laparoscopic surgery and the depth of anesthesia should be regulated.