中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
12期
828-831
,共4页
舒芬太尼%瑞芬太尼%吸入麻醉%血压%呼吸
舒芬太尼%瑞芬太尼%吸入痳醉%血壓%呼吸
서분태니%서분태니%흡입마취%혈압%호흡
Sufentanil%Remifentanil%Inhalation anesthesia%Blood pressure%Breathing
目的 比较靶控输注舒芬太尼与瑞芬太尼复合吸入麻醉对手术患者血流动力学及术后恢复情况的影响.方法 北京大学第一医院2008年1-7月40例择期全麻手术患者,美国麻醉医师协会分级Ⅰ～Ⅱ级,年龄18～65岁,体质指数(BMI)＜30.经医院伦理委员会审核,选用数字随机法随机分为瑞芬太尼组(R组)和舒芬太尼组(S组),每组20例,R组靶控输注瑞芬太尼(血浆靶浓度为3 ng/ml)复合0.9最低肺泡有效浓度(MAC)的吸入麻醉药;S组靶控输注舒芬太尼(血浆靶浓度为0.3 ng/ml)复合0.9最低肺泡有效浓度(MAC)的吸入麻醉药.瑞芬太尼在手术结束时停药,舒芬太尼在手术结束前40～60 min停止输注.记录麻醉中血压、心率及术后呼吸恢复时间、拔管时间,观察术后疼痛情况及呼吸抑制情况.结果 麻醉后两组患者的血压、心率均显著低于术前基础值(P＜0.05),但是都还在基础值±30%范围内;两组间血压差异无统计学意义,R组全麻诱导后,气管插管后,切皮时,手术结束以及气管拔管时的心率低于S组(P＜0.05).R组呼吸恢复时间及拔管时间均显著短于S组[(1.8±1.4)min比(2.9±1.5)min,P＜0.05;(6.8±3.9)min比(9.1±2.8)min,P＜0.05].R组有7例患者术后视觉模拟评分(VAS)≥4,需要吗啡补救镇痛治疗.结论 靶控输注舒芬太尼或瑞芬太尼复合吸入麻醉,对血流动力学的影响是相似的;瑞芬太尼麻醉的患者术后呼吸恢复更快,拔管更早,但应及早给予镇痛治疗.
目的 比較靶控輸註舒芬太尼與瑞芬太尼複閤吸入痳醉對手術患者血流動力學及術後恢複情況的影響.方法 北京大學第一醫院2008年1-7月40例擇期全痳手術患者,美國痳醉醫師協會分級Ⅰ～Ⅱ級,年齡18～65歲,體質指數(BMI)＜30.經醫院倫理委員會審覈,選用數字隨機法隨機分為瑞芬太尼組(R組)和舒芬太尼組(S組),每組20例,R組靶控輸註瑞芬太尼(血漿靶濃度為3 ng/ml)複閤0.9最低肺泡有效濃度(MAC)的吸入痳醉藥;S組靶控輸註舒芬太尼(血漿靶濃度為0.3 ng/ml)複閤0.9最低肺泡有效濃度(MAC)的吸入痳醉藥.瑞芬太尼在手術結束時停藥,舒芬太尼在手術結束前40～60 min停止輸註.記錄痳醉中血壓、心率及術後呼吸恢複時間、拔管時間,觀察術後疼痛情況及呼吸抑製情況.結果 痳醉後兩組患者的血壓、心率均顯著低于術前基礎值(P＜0.05),但是都還在基礎值±30%範圍內;兩組間血壓差異無統計學意義,R組全痳誘導後,氣管插管後,切皮時,手術結束以及氣管拔管時的心率低于S組(P＜0.05).R組呼吸恢複時間及拔管時間均顯著短于S組[(1.8±1.4)min比(2.9±1.5)min,P＜0.05;(6.8±3.9)min比(9.1±2.8)min,P＜0.05].R組有7例患者術後視覺模擬評分(VAS)≥4,需要嗎啡補救鎮痛治療.結論 靶控輸註舒芬太尼或瑞芬太尼複閤吸入痳醉,對血流動力學的影響是相似的;瑞芬太尼痳醉的患者術後呼吸恢複更快,拔管更早,但應及早給予鎮痛治療.
목적 비교파공수주서분태니여서분태니복합흡입마취대수술환자혈류동역학급술후회복정황적영향.방법 북경대학제일의원2008년1-7월40례택기전마수술환자,미국마취의사협회분급Ⅰ～Ⅱ급,년령18～65세,체질지수(BMI)＜30.경의원윤리위원회심핵,선용수자수궤법수궤분위서분태니조(R조)화서분태니조(S조),매조20례,R조파공수주서분태니(혈장파농도위3 ng/ml)복합0.9최저폐포유효농도(MAC)적흡입마취약;S조파공수주서분태니(혈장파농도위0.3 ng/ml)복합0.9최저폐포유효농도(MAC)적흡입마취약.서분태니재수술결속시정약,서분태니재수술결속전40～60 min정지수주.기록마취중혈압、심솔급술후호흡회복시간、발관시간,관찰술후동통정황급호흡억제정황.결과 마취후량조환자적혈압、심솔균현저저우술전기출치(P＜0.05),단시도환재기출치±30%범위내;량조간혈압차이무통계학의의,R조전마유도후,기관삽관후,절피시,수술결속이급기관발관시적심솔저우S조(P＜0.05).R조호흡회복시간급발관시간균현저단우S조[(1.8±1.4)min비(2.9±1.5)min,P＜0.05;(6.8±3.9)min비(9.1±2.8)min,P＜0.05].R조유7례환자술후시각모의평분(VAS)≥4,수요마배보구진통치료.결론 파공수주서분태니혹서분태니복합흡입마취,대혈류동역학적영향시상사적;서분태니마취적환자술후호흡회복경쾌,발관경조,단응급조급여진통치료.
Objective To compare the effect of remifentanil versus sufentanil with target-controlled infusion in combination with inhalation anesthesia for surgical patients on the parameters of hemodynamics and postoperative recovery.Methods Forty ASA Ⅰ - Ⅱ patients aged 18 -65 years old with BMI (body mass index) ＜ 30,undergoing colectomy or pedical screw interfix were enrolled.Upon the approval of institutional Ethics Committee,they were randomized to receive remifentanil or sufentanil at a target plasma concentration of 3 ng/ml and 0.3 ng/ml respectively in combination of inhalated anesthesia at 0.9 MAC (minimal alveolar concentration).The infusion of remifentanil was discontinued at the end of surgery while the infusion of sufentanil at 40 -60 minutes before the end of surgery.The arterial blood pressure( ABP),heart rate (HR),electrocardiogram (ECG)and pulse blood oxygen saturation during anesthesia were monitored.The time between the termination of anesthetic use and recovery of spontaneous breathing and extubation were observed.And the incidence of postoperative pain and respiratory depression were recorded.Results As compared with the baseline values,BP and HR decreased significantly in both groups.BP was similar in both groups whereas HR was lower in Group R than that in Group S at post-induction,postintubation,incision,the end of surgery and extubation ( P ＜ 0.05 ).The time from termination of anesthesia to recovery of spontaneous breathing was 1.8 ± 1.4 min in Group R.And it was significantly shorter than that in Group S(2.9 ± 1.5 min) (P ＜0.05).The time from termination of anesthetic use to extubation was 6.8 ±3.9 min in Group R.And it was also significantly shorter than that in Group S(9.1 ±2.8 min) (P＜0.05).Seven patients experienced postoperative pain with visual analogue scale (VAS) ＞4.And morphine was used for rescue analgesia in recovery room.Conclusion When combined with inhalation anesthesia,the effects on hemodynamics are similar between the patients receiving the target-controlled infusions of remifentanil and sufentanil.Remifentanil offers a shorter time to recovery of spontaneous breathing and tracheal extubation.
