中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2010年
8期
919-921
,共3页
二异丙酚%瑞芬太尼%药物释放系统%重症肌无力%胸腺切除术
二異丙酚%瑞芬太尼%藥物釋放繫統%重癥肌無力%胸腺切除術
이이병분%서분태니%약물석방계통%중증기무력%흉선절제술
Propofol%Remifentanil%Drug delivery systems%Myasthenia gravis%Thymectomy
目的 探讨靶控输注异丙酚复合瑞芬太尼用于重症肌无力患者胸腺切除术的效果.方法 择期拟行胸腺切除术的重症肌无力患者45例,ASA分级Ⅰ或Ⅱ级,年龄16～64岁,体重45～95 kg.麻醉诱导:靶控输注异丙酚(血浆靶浓度4μg/ml)和瑞芬太尼(效应室靶浓度4 ng/ml),2%利多卡因2～3 ml行气管内表面麻醉后行气管插管,机械通气.麻醉维持:靶控输注异丙酚,血浆靶浓度3～5 μg/ml;靶控输注瑞芬太尼,效应室靶浓度3～6 ng/ml.术毕前30 min,静脉注射舒芬太尼0.15μg/kg进行镇痛.记录首次气管插管的成功情况、切皮时患者体动反应情况、苏醒时间、拔除气管导管时间、术毕拔除气管导管情况及心血管事件的发生情况.结果 所有患者均顺利完成气管插管,首次气管插管成功率100%.切皮时无一例患者发生体动反应;苏醒时间1.0～3.2 min;拔除气管导管时间2.6～7.0 min;术毕拔除气管导管率100%.麻醉诱导期间有3例患者发生心动过缓,4例患者发生低血压,对症处理后均恢复正常;术中有3例患者发生心动过缓,对症处理后恢复正常.结论 靶控输注异丙酚复合瑞芬太尼麻醉可安全有效地用于重症肌无力患者胸腺切除手术.
目的 探討靶控輸註異丙酚複閤瑞芬太尼用于重癥肌無力患者胸腺切除術的效果.方法 擇期擬行胸腺切除術的重癥肌無力患者45例,ASA分級Ⅰ或Ⅱ級,年齡16～64歲,體重45～95 kg.痳醉誘導:靶控輸註異丙酚(血漿靶濃度4μg/ml)和瑞芬太尼(效應室靶濃度4 ng/ml),2%利多卡因2～3 ml行氣管內錶麵痳醉後行氣管插管,機械通氣.痳醉維持:靶控輸註異丙酚,血漿靶濃度3～5 μg/ml;靶控輸註瑞芬太尼,效應室靶濃度3～6 ng/ml.術畢前30 min,靜脈註射舒芬太尼0.15μg/kg進行鎮痛.記錄首次氣管插管的成功情況、切皮時患者體動反應情況、囌醒時間、拔除氣管導管時間、術畢拔除氣管導管情況及心血管事件的髮生情況.結果 所有患者均順利完成氣管插管,首次氣管插管成功率100%.切皮時無一例患者髮生體動反應;囌醒時間1.0～3.2 min;拔除氣管導管時間2.6～7.0 min;術畢拔除氣管導管率100%.痳醉誘導期間有3例患者髮生心動過緩,4例患者髮生低血壓,對癥處理後均恢複正常;術中有3例患者髮生心動過緩,對癥處理後恢複正常.結論 靶控輸註異丙酚複閤瑞芬太尼痳醉可安全有效地用于重癥肌無力患者胸腺切除手術.
목적 탐토파공수주이병분복합서분태니용우중증기무력환자흉선절제술적효과.방법 택기의행흉선절제술적중증기무력환자45례,ASA분급Ⅰ혹Ⅱ급,년령16～64세,체중45～95 kg.마취유도:파공수주이병분(혈장파농도4μg/ml)화서분태니(효응실파농도4 ng/ml),2%리다잡인2～3 ml행기관내표면마취후행기관삽관,궤계통기.마취유지:파공수주이병분,혈장파농도3～5 μg/ml;파공수주서분태니,효응실파농도3～6 ng/ml.술필전30 min,정맥주사서분태니0.15μg/kg진행진통.기록수차기관삽관적성공정황、절피시환자체동반응정황、소성시간、발제기관도관시간、술필발제기관도관정황급심혈관사건적발생정황.결과 소유환자균순리완성기관삽관,수차기관삽관성공솔100%.절피시무일례환자발생체동반응;소성시간1.0～3.2 min;발제기관도관시간2.6～7.0 min;술필발제기관도관솔100%.마취유도기간유3례환자발생심동과완,4례환자발생저혈압,대증처리후균회복정상;술중유3례환자발생심동과완,대증처리후회복정상.결론 파공수주이병분복합서분태니마취가안전유효지용우중증기무력환자흉선절제수술.
Objective To investigate the efficacy of anesthesia with propofol-remifentanil given by targetcontrolled infusion (TCI) for thymectomy in patients with myasthenia gravis ( MG). Methods Forty-five ASA Ⅰ or Ⅱ MG patients aged 16-64 yr weighing 45-95 kg undergoing thymectomy were studied. Anesthesia was induced with TCI of propofol (target plasma concentration 4 μg/ml) and remifentanil (target effect-site concentration 4 ng/ml). Thracheal intubation was performed after topical anesthesia with 2% lidocaine 2-3 ml and then the patients were mechanically ventilated. Anesthesia was maintained with TCI of propofol ( target plasma concentration 3-5 μg/ml) and remifentail (target effect-site concentration 3-6 ng/ml). Sufentanil 0.15 μg/kg was injected intravenously for analgesia 30 min before operation. The success rate of intubationat at first attempt, body movement in response to skin incision, recovery time, extubation time, extubation condition at the end of operation and cardiovascular events were recorded. Results Thracheal intubation was performed successfully in all patients. The success rate of intubation at first attempt was 100%. No body movement occurred during skin incision in the patients.Recovery time was 1.0-3.2 min and extubation time 2.6-7.0 min. All patients were successfully extubated at the end of operation. Bradycardia developed in 3 patients and hypotension in 4 patients during induction, but they all returned to normal after symptomatic treatment. Bradycardia developed in 3 patients during operation, but returned to normal after symptomatic treatment. Conclusion Anesthesia with TCI of propofol and remifentanil can be used safely and effectively in MG patients undergoing thymectomy.
