CAJ | 학술논문

目的评价异氟醚(Iso)全麻时联合使用舒芬太尼和雷米芬太尼辅助镇痛效果.方法择期腹部手术患者100例,年龄65～70岁,随机分为舒芬太尼诱导雷米芬太尼维持组(SR组)、芬太尼诱导雷米芬太尼维持组(FR组)、单纯舒芬太尼组(SS组)、单纯雷米芬太尼组(RR组)和单纯芬太尼组(FF组),每组20例.术中根据脑电双频指数(BIS)调控麻醉深度.观察诱导前(T_0)、诱导插管时(T_1)、插管后1 min(T_2)、插管后5 min(T_3)、切皮1 min(T_4)、切皮5 min(T_5)、切皮10 min(T6)、腹腔探查时(T_7)的MAP、HR、BIS值和呼气末异氟醚浓度(C_(ET)I_(SO));记录术中流泪、体动、知晓情况,麻醉苏醒质量,术后4 h VAS评分,PCIA药物用量及术后并发症发生情况.结果 FF组麻醉期间C_(ET)I_(SO)高于SR组(P<0.05).术后4h VAS评分及术后镇痛药用量RR、FR组高于SR、SS和FF组(P<0.05或P<0.01),FR组低于RR组(P<0.05).SR、FR和RR组拔管时间短于SS、FF组(P<0.01).术后躁动RR组高于其他组(P<0.05),五组均未见明显呼吸抑制.结论接受舒芬太尼诱导雷米芬太尼维持辅助镇痛的老年患者术中血流动力学稳定,苏醒快速,不良反应少.
목적 평개이불미(Iso)전마시연합사용서분태니화뢰미분태니보조진통효과.방법 택기복부수술환자100례,년령65～70세,수궤분위서분태니유도뢰미분태니유지조(SR조)、분태니유도뢰미분태니유지조(FR조)、단순서분태니조(SS조)、단순뢰미분태니조(RR조)화단순분태니조(FF조),매조20례.술중근거뇌전쌍빈지수(BIS)조공마취심도.관찰유도전(T_0)、유도삽관시(T_1)、삽관후1 min(T_2)、삽관후5 min(T_3)、절피1 min(T_4)、절피5 min(T_5)、절피10 min(T6)、복강탐사시(T_7)적MAP、HR、BIS치화호기말이불미농도(C_(ET)I_(SO));기록술중류루、체동、지효정황,마취소성질량,술후4 h VAS평분,PCIA약물용량급술후병발증발생정황.결과 FF조마취기간C_(ET)I_(SO)고우SR조(P<0.05).술후4h VAS평분급술후진통약용량RR、FR조고우SR、SS화FF조(P<0.05혹P<0.01),FR조저우RR조(P<0.05).SR、FR화RR조발관시간단우SS、FF조(P<0.01).술후조동RR조고우기타조(P<0.05),오조균미견명현호흡억제.결론 접수서분태니유도뢰미분태니유지보조진통적노년환자술중혈류동역학은정,소성쾌속,불량반응소.
Objective To evaluate the outcomes of application of sufentanil for induction andremifentanil for maintenance as an adjuvant to general anestheia in the elderly.Methods One hundredpatients,aged 65-70 years old,undergoing abdominal surgery were randomly divided into 5 groupswith 20 cases each.The depeth of general anesthesia with isoflurane inhalation was modulated by BIS.Mean arterial pressure(MAP).Heart rate(HR),bispectral index(BIS),and end tidal isofluraneconcentration(C_(ET)I_(SO))at the baseline(T_0),intubution(T_1),1 min(T_2)and 5 min after intubution(T_3),1 min(T_4),5 min(T_5)and 10 min after skin incision(T_6)and the abdominal exploration(T_7)were recorded.Visual analogue scale(VAS)pain score was assessed at 4 h after operation.Consumption of sufentanil in the first postoperative 24 h during PCIA was recorded. Recovery profileand perioperative side effects were also collected.Results The C_(ET)I_(SO) was higher in group FF thanthat in groups of SR,FR,SS and RR during anesthesia(P<0.05).VAS at 4 h after operation andconsumption of analgesics during 24-hours were higher in group RR and FR than those in groups ofSR.SS and FF(P<0.05 or P<0.01).The time of extubation was shorter in groups of SR,FR andRR than those in groups of SS and FF(P<0.01).The percentage of restlessness was higher in groupRR than that in groups of SR,FR,SS and FF(P<0.05).Conclusion Application of sufentaniI forinduction and remifentanil for maintenance as an adjvant to general anestheia in the elderly has theadvantages of stable hemodynamics.early recovery from anesthesia and less adverse effects.