中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2010年
10期
1156-1159
,共4页
赵丽云%徐源%汪晓楠%刘醒帅%卿恩明
趙麗雲%徐源%汪曉楠%劉醒帥%卿恩明
조려운%서원%왕효남%류성수%경은명
吗啡%芬太尼%麻醉,全身%冠状动脉旁路移植术,非体外循环%麻醉恢复期
嗎啡%芬太尼%痳醉,全身%冠狀動脈徬路移植術,非體外循環%痳醉恢複期
마배%분태니%마취,전신%관상동맥방로이식술,비체외순배%마취회복기
Morphine%Fentanyl%Anesthesia,general%Coronary artery bypass,off-pump%Anesthesia recovery period
目的 探讨吗啡-芬太尼复合麻醉下非体外循环下冠状动脉旁路移植术患者的转归.方法 拟在非体外循环下行冠状动脉旁路移植术的患者72例,年龄41～64岁,随机分为2组(n=36):芬太尼复合麻醉组(F组)和吗啡-芬太尼复合麻醉组(MF组).静脉注射芬太尼10～20μg/kg、咪达唑仑0.1 mg/kg、依托咪酯0.3 mg/kg和维库溴铵0.1 mg/kg进行麻醉诱导,气管插管后行机械通气.麻醉维持:MF组静脉输注吗啡0.15 mg·kg-1·h-1+芬太尼8μg·kg-1·hZ-1,F组静脉输注芬太尼10μg·kg-1·h-1,2组均吸入0.5%～2.0%异氟烷,间断静脉注射维库溴铵4 rag.2组术后进行静脉镇痛,MF组和F组分别静脉输注吗啡0.75 mg/h吗啡和芬太尼10μg/h.分别于术前(基础状态)、术后1、2、3 d进行恢复质量评分(QoR评分).于拔除气管导管后15 min、4 h、24 h时进行Ramsay镇静评分.记录术后不良反应的发生情况.结果 与F组比较,MF组术后QoR评分升高,术后发热发生率降低(P＜0.05或0.01),Ramsay镇静评分和其他不良反应的发生率差异无统计学意义(P＞0.05).结论与芬太尼复合麻醉比较,吗啡-芬太尼复合麻醉有利于非体外循环下冠状动脉旁路移植术患者预后.
目的 探討嗎啡-芬太尼複閤痳醉下非體外循環下冠狀動脈徬路移植術患者的轉歸.方法 擬在非體外循環下行冠狀動脈徬路移植術的患者72例,年齡41～64歲,隨機分為2組(n=36):芬太尼複閤痳醉組(F組)和嗎啡-芬太尼複閤痳醉組(MF組).靜脈註射芬太尼10～20μg/kg、咪達唑崙0.1 mg/kg、依託咪酯0.3 mg/kg和維庫溴銨0.1 mg/kg進行痳醉誘導,氣管插管後行機械通氣.痳醉維持:MF組靜脈輸註嗎啡0.15 mg·kg-1·h-1+芬太尼8μg·kg-1·hZ-1,F組靜脈輸註芬太尼10μg·kg-1·h-1,2組均吸入0.5%～2.0%異氟烷,間斷靜脈註射維庫溴銨4 rag.2組術後進行靜脈鎮痛,MF組和F組分彆靜脈輸註嗎啡0.75 mg/h嗎啡和芬太尼10μg/h.分彆于術前(基礎狀態)、術後1、2、3 d進行恢複質量評分(QoR評分).于拔除氣管導管後15 min、4 h、24 h時進行Ramsay鎮靜評分.記錄術後不良反應的髮生情況.結果 與F組比較,MF組術後QoR評分升高,術後髮熱髮生率降低(P＜0.05或0.01),Ramsay鎮靜評分和其他不良反應的髮生率差異無統計學意義(P＞0.05).結論與芬太尼複閤痳醉比較,嗎啡-芬太尼複閤痳醉有利于非體外循環下冠狀動脈徬路移植術患者預後.
목적 탐토마배-분태니복합마취하비체외순배하관상동맥방로이식술환자적전귀.방법 의재비체외순배하행관상동맥방로이식술적환자72례,년령41～64세,수궤분위2조(n=36):분태니복합마취조(F조)화마배-분태니복합마취조(MF조).정맥주사분태니10～20μg/kg、미체서륜0.1 mg/kg、의탁미지0.3 mg/kg화유고추안0.1 mg/kg진행마취유도,기관삽관후행궤계통기.마취유지:MF조정맥수주마배0.15 mg·kg-1·h-1+분태니8μg·kg-1·hZ-1,F조정맥수주분태니10μg·kg-1·h-1,2조균흡입0.5%～2.0%이불완,간단정맥주사유고추안4 rag.2조술후진행정맥진통,MF조화F조분별정맥수주마배0.75 mg/h마배화분태니10μg/h.분별우술전(기출상태)、술후1、2、3 d진행회복질량평분(QoR평분).우발제기관도관후15 min、4 h、24 h시진행Ramsay진정평분.기록술후불량반응적발생정황.결과 여F조비교,MF조술후QoR평분승고,술후발열발생솔강저(P＜0.05혹0.01),Ramsay진정평분화기타불량반응적발생솔차이무통계학의의(P＞0.05).결론여분태니복합마취비교,마배-분태니복합마취유리우비체외순배하관상동맥방로이식술환자예후.
Objective To investigate the outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCABG) under morphine-fentanyl combined anesthesia. Methods Seventy-two patients aged 41-64 yr undergoing OPCABG were randomly divided into 2 groups (n = 36 each): Ⅰ group morphine + fentanyl (group MF) and Ⅱ group fentanyl (group F). Anesthesia was induced with midazolam, etomidate, and vecuronium.Fentanyl 10-20 μg/kg was given iv when needed. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintsined with inhalation of 0.5%-2.0% isoflurane and intermittent iv boluses of vecuronium in both groups. Morphine 0.15 mg·kg-1·h-1 + fentanyl 8 μg·kg-1·h-1 were infused during operation in group MF, while in group F fentanyl 10 μg·kg-1·h-1 was infused. Morphine 0.75 mg/h was infused in group MF or fentanyl 10 μg/h in group F for postoperative analgesia after extubation. Recovery from anesthesia was assessed using a nine point (QoR) questionnaire. Pain was measured with VAS score and sedation with Ramsay sedation score ( 1 = fully awake, 6 = asleep, no response to verbal stimulus). The postoperative complications were recorded. Results QoR scores were significantly higher in group MF and in group F. The incidence of postoperative febrile reaction was significantly reduced in group MF. There was no significant difference in Ramsay sedation score and other postoperative complications between the 2 groups. Conclusion Morphine-fentanyl combined anesthesia is more beneficial for the prognosis in patients undergoing OPCABG compared with fentanyl combined anesthesia.
