瑞芬太尼复合丙泊酚静脉麻醉在喉显微手术中的应用  

Efficacy of remifentanil combined with propofol venous anesthesia in laryneal microsurgery

作　　者：尚宇 顾佩菲[2] 赵璠 

机构地区：[1]解放军第463医院麻醉科,沈阳110042 [2]沈阳药科大学药理教研室,沈阳110016

出　　处：《中国新药杂志》2006年第10期814-817,共4页Chinese Journal of New Drugs

摘　　要：目的:观察喉显微手术应用瑞芬太尼或芬太尼复合丙泊酚麻醉对血流动力学及术后清醒过程的影响。方法:105例ASAⅠ～Ⅱ级择期支撑喉镜下声带手术患者,随机分成三组,丙泊酚组(P组),芬太尼+丙泊酚组(FP组)和瑞芬太尼+丙泊酚组(REP组),每组35例。P组采用2%丙泊酚2．0～2．5 mg·kg^(-1),琥珀胆碱1．5 mg·kg^(-1)诱导,FP和REP组分别于诱导前静注芬太尼3．0μg·kg^(-1)和瑞芬太尼1．0μg·kg^(-1)。术中间断推注丙泊酚维持麻醉,观察诱导前、插管前1 min、插管后1 min、置支撑喉镜时及拔管时的收缩压(SBP)、舒张压(DBP)和心率(HR)的变化,并记录丙泊酚用量及麻醉恢复时间。结果:三组在诱导后插管前HR,SBP,DBP较诱导前均有明显下降(P＜0．05),但P组在气管插管后、置支撑喉镜及拔管时SBP,DBP,HR较诱导前有明显升高(P＜0．05),而FP组和REP组与诱导前比较无明显差异(P＞0．05)。FP组和REP组各时间点SBP,DBP,HR组间比较差异无显著性(P＞0．05)。术中丙泊酚追加量和总用药量P和FP组显著高于REP组(P＜0．05),苏醒时间P和FP组显著长于REP组(P＜0．05)。结论:瑞芬太尼复合丙泊酚麻醉应用于喉显微手术中血流动力学稳定,术后苏醒时间短,是比较理想的麻醉方法。Objective ： To assess the effect of remifentanil or fentanyl plus propofol anesthesia on homodynamics and recovery time in laryneal microsurgery. Methods： One-hundred and five ASA Ⅰ-Ⅱ patients undergoing laryneal microsurgery were randomized 1 ： 1 ： 1 to assign to one of three anesthesia groups： group P with general anesthesia induction by 2% propofol 2.0 - 2.5 mg. kg^-1, scoline 1.5 mg·kg^-1, group FP with intravenous injection of fentanyl 3.0μg· kg^-1 or group REP with intravenous injection of remifentanil 1.0μg· kg^-1 before induction. All patients were given propofol during operation. The efficacy of anesthetic treatments was assessed based on changes of SBP, DBP and HR at certain timepoints pre-, during and post surgery, propofol dose used and recovery onset post anesthesia. Resuits： The patients in three groups all significantly decreased the HR, SBP and DBP after induction （P 〈 0.05）. The patients in group P experienced significant increases of HR, SBP and DBP at the time of intubation, extubation or placing suspension laryngoscopy compared with the ones before induction （P 〈 0.05）. The patients in groups FP and REP showed no significant changes of HR, SBP and DBP compared with the ones before induction （P 〉 0.05）. No statistical difference between group FP and REP was found in the HR, SBP and DBP status （P 〉 0.05）. The super-additional doses and total doses of propofol patient were administered in groups P and FP were significantly higher than those in group REP （P 〈 0.05 ）. The recovery onset in group REP was significantly faster than that in groups P and FP （P 〈 0.05）. Conclusion： Combination of remifentanil with propofol offered better anesthetic effect and prognosis in laryneal microsurgery.

关 键 词：瑞芬太尼 芬太尼 血流动力学 支撑喉镜 喉显微手术 

分 类 号：R971[医药卫生—药品] R614[医药卫生—药学]