CAJ | 학술논문

目的比较TCI舒芬太尼和瑞芬太尼复合麻醉用于腹腔镜下结直肠癌根治术病人的麻醉恢复质量.方法择期行腹腔镜下结直肠癌根治术病人40例,年龄40～64岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将病人随机分为2组(n=20):TCI瑞芬太尼复合麻醉组(R组)和TCI舒芬太尼复合麻醉组(S组).麻醉诱导:静脉注射阿托品0.25 mg,TCI异丙酚和瑞芬太尼(或舒芬太尼),异丙酚血浆靶浓度(Cp)为4.0μg/ml,瑞芬太尼Cp为4.0 ng/ml,舒芬太尼效应室靶浓度(Ce)为0.4 ng/ml,静脉注射维库溴铵0.1 mg/kg,气管插管后机械通气.麻醉维持:TCI异丙酚,瑞芬太尼Cp和舒芬太尼Ce分别为2.5、0.25 ng/ml,间断静脉注射维库溴铵0.03 mg/kg,调节异丙酚Cp和七氟醚浓度,维持Norcotrend指数37～56.记录苏醒时间、拔除气管导管时间和麻醉恢复期不良事件的发生情况.结果与R组比较,S组苏醒时间和拔除气管导管时间延长,但是高血压、心动过速、呛咳、躁动和寒颤的发生率降低(P＜0.05)；2组均无一例病人发生苏醒延迟或呼吸抑制.结论与TCI瑞芬太尼复合麻醉比较,TCI舒芬太尼复合麻醉用于腹腔镜下结直肠癌根治术病人麻醉恢复质量较高.
목적 비교TCI서분태니화서분태니복합마취용우복강경하결직장암근치술병인적마취회복질량.방법 택기행복강경하결직장암근치술병인40례,년령40～64세,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장병인수궤분위2조(n=20):TCI서분태니복합마취조(R조)화TCI서분태니복합마취조(S조).마취유도:정맥주사아탁품0.25 mg,TCI이병분화서분태니(혹서분태니),이병분혈장파농도(Cp)위4.0μg/ml,서분태니Cp위4.0 ng/ml,서분태니효응실파농도(Ce)위0.4 ng/ml,정맥주사유고추안0.1 mg/kg,기관삽관후궤계통기.마취유지:TCI이병분,서분태니Cp화서분태니Ce분별위2.5、0.25 ng/ml,간단정맥주사유고추안0.03 mg/kg,조절이병분Cp화칠불미농도,유지Norcotrend지수37～56.기록소성시간、발제기관도관시간화마취회복기불량사건적발생정황.결과 여R조비교,S조소성시간화발제기관도관시간연장,단시고혈압、심동과속、창해、조동화한전적발생솔강저(P＜0.05)；2조균무일례병인발생소성연지혹호흡억제.결론 여TCI서분태니복합마취비교,TCI서분태니복합마취용우복강경하결직장암근치술병인마취회복질량교고.
Objective To compare the quality of emergence from TCI of sufentanil and remifentanil supplementing propofol-sevoflurane anesthesia in patients undergoing radical colo-rectal cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients of both sexes aged 40-64 yr undergoing elective radical colo-rectal cancer resection were allocated into 2 groups ( n =20 each):sufentanil group (group S) and remifentanil group (group R).Anesthesia was induced with propofol TCI at plasma concentration (Cp) of 4.0 μg/ml in both groups and sufentanil TCI (effect-site concentration Ce =0.4 ng/ml ) or remifentanil TCI ( Cp =4.0 ng/ml).Tracheal intubation was facilitated with vecuronium 0.1 mg/kg.The patients were mechanically ventilated (VT =8-10 ml/kg,RR =12-16 bpm).PErCO2 was maintained at 30-40 mm Hg.Anesthesia was maintained with propofol TCI-sevoflurane supplemented with sufentanil (Ce=0.25 ng/ml) or remifentanil (Cp=2.5 ng/ml).The depth of anesthesia was maintained at Narcotrend index of 37-56 by adjusting Cp of propofol TCI and sevoflurane concentration.The infusion of sufentanil was discontinued at 40 min before the conclusion of the operation while remifentanil was administered until the end of surgery.The incidence of postoperative adverse events,the time from the end of operation to eye openg and the time to extubation were recorded.Reesults The two groups were comparable with respect to demographic data.Neither group developed prolonged emergence and respiratory depression but the time from the end of operation to eye opening and the time to extubation were significantly longer in group S than in group R.The incidence of hypertension and tachycardia,agitation,shivering aad coughing were significantly lower in group S than in group R.Conclusion The quality of emergence from sufentanil supplementing propofol-sevoflurane anesthesia is higher than that from remifentanil.