CAJ | 학술논문

目的探讨芬太尼和瑞芬太尼对于肥胖患者全身麻醉效果及复苏的影响,探索联合应用两种药物的可行性,并找到较为可行的联合方式.方法按随机区组设计将实施全身麻醉的肥胖患者分为4组,每组20例,分别是芬太尼组(F组),瑞芬太尼组(R组),芬太尼复合瑞芬太尼l组(RF1组)和芬太尼复合瑞芬太尼2组(RF2组),比较4组患者的全身麻醉中的安全性和有效性以及麻醉后的复苏质量.结果麻醉诱导后即刻R组和RF2组在预防插管等刺激所引起的平均动脉压(MAP)和促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)分别为(63±7) mm Hg(1 mm Hg=0.133 kPa)、(8.8±2.5)pmol/L和(64±9) mm Hg、( 8.5±2.8) pmol/L,与F组(69±10) mm Hg、(10.8±2.6) pmol/L比较降低(P＜0.05).麻醉后R组拔管时间和睁眼时间及定向力恢复时间(14.9±1.9)、(12.0±1.7)、(15.4±2.3) min、RF2组拔管时间和睁眼时间及定向力恢复时间(16.3±3.4)、(15.7±1.4)、(12.6±1)min和F组(22.7±1.7)、(14.8±1.6)、(30.0±3.8) min相比均较短(P＜0.05),R组和RF2组停药后1 h OAA/S评分分别为(3.5±0.7)、(3.5±0.8),较F组(2.2±0.8)大(P＜0.05)患者清醒程度高,但是R组停药后lh和3h的视觉模拟(visual analog scale,VAS)评分分别为(5.3±1.0)、(5.3±0.8)较F组(2.3±0.6)和(2.9±0.6)高(P＜0.05),RF2组和F组评分差异无统计学意义(P＞0.05).结论以RF2组方式联合应用芬太尼和瑞芬太尼不仅在全身麻醉中安全有效,而且复苏质量较好.
목적 탐토분태니화서분태니대우비반환자전신마취효과급복소적영향,탐색연합응용량충약물적가행성,병조도교위가행적연합방식.방법 안수궤구조설계장실시전신마취적비반환자분위4조,매조20례,분별시분태니조(F조),서분태니조(R조),분태니복합서분태니l조(RF1조)화분태니복합서분태니2조(RF2조),비교4조환자적전신마취중적안전성화유효성이급마취후적복소질량.결과 마취유도후즉각R조화RF2조재예방삽관등자격소인기적평균동맥압(MAP)화촉신상선피질격소(adrenocorticotropic hormone,ACTH)분별위(63±7) mm Hg(1 mm Hg=0.133 kPa)、(8.8±2.5)pmol/L화(64±9) mm Hg、( 8.5±2.8) pmol/L,여F조(69±10) mm Hg、(10.8±2.6) pmol/L비교강저(P＜0.05).마취후R조발관시간화정안시간급정향력회복시간(14.9±1.9)、(12.0±1.7)、(15.4±2.3) min、RF2조발관시간화정안시간급정향력회복시간(16.3±3.4)、(15.7±1.4)、(12.6±1)min화F조(22.7±1.7)、(14.8±1.6)、(30.0±3.8) min상비균교단(P＜0.05),R조화RF2조정약후1 h OAA/S평분분별위(3.5±0.7)、(3.5±0.8),교F조(2.2±0.8)대(P＜0.05)환자청성정도고,단시R조정약후lh화3h적시각모의(visual analog scale,VAS)평분분별위(5.3±1.0)、(5.3±0.8)교F조(2.3±0.6)화(2.9±0.6)고(P＜0.05),RF2조화F조평분차이무통계학의의(P＞0.05).결론 이RF2조방식연합응용분태니화서분태니불부재전신마취중안전유효,이차복소질량교호.
Objective Our main objective was to compare the effects of fentanyl and remifentanil on anesthesia and postoperative recovery in obese patients,and to explore the influence of combination of the two drugs.Methods 80 obese patients undertaking general anesthesia were randomly divided into four groups(n=20) Group F(fentanyl ),group R (remifentanil),group RF1 (fentanyl + remifentanil for induction and fentanvl during maintenance) group RF2( fentanyl + remifentanil for induction,and remifentanil during maintenance).Heart rate,mean arterial pressure(MAP),the level adrenocorticotropic hormone (ACTH),time to extubation,time to eyes opened,OAA/S score and visual analog scale (VAS) score were recorded.Results MAP and ACTH in group R[ (63±7) mm Hg( 1 mm Hg=0.133 kPa),(8.8±2.5) pmol/L) ],group RF2[ (64±9) mm Hg,(8.5±2.8) pmol/L] were lower than that of group F [(69±10) mm Hg,(10.8±2.6) pmol/L] (P＜0.05) after induction.Time to extubation,time to eyes open and orientation after anesthesia in group R (14.9±1.9,12.0±1.7 and 15.4±2.3),group RF2 (16.3±3.4,15.7±1.4 and 12.6±1.1) were shorter than group F(22.7±1.7,14.8±1.6 and 30.0±3.8) (P＜0.05).The OAA/S score of group R(3.5±0.7) and group RF2(3.5±0.8)1 h after drug discontinuance were higher(P＜0.05) than that of group F(2.2±0.8).The quality of recovery in group R and RF2 were better.But the VAS score of group R 1 h(5.3±1.0),3 h(5.3±0.8) after drug discontinuance were higher(P＜0.05 )than group F(2.3±0.6,2.9±0.6).There is no significant difference between the VAS score of group RF2 and group F (P＞0.05).Conclusion Combined of fentanyl and remifentanil is safe and effective in general anesthesia,also achieves high quality of recovery.