瑞芬太尼复合异丙酚静脉麻醉在肝癌射频消融术中的应用  

Application of Total Intravenous Anesthesia with Remifentanyl and Propofol to Radiofrequency Ablation

作　　者：李毅[1] 黄婉[1] 龙浴辉[1] 李伟[1] 王剑[1] 陈敏山[1] 许梅曦[1] 

机构地区：[1]华南肿瘤学国家重点实验室

出　　处：《癌症》2007年第3期322-324,共3页Chinese Journal of Cancer

摘　　要：背景与目的:经皮射频消融是治疗小肝癌的最新有效的微创手术,但手术的麻醉尚未得到重视,一般的局部麻醉或者单次使用镇痛药物均无法获得满意的效果。本研究将瑞芬太尼复合异丙酚应用于经皮射频消融治疗肝癌的麻醉,探讨其临床效果以及安全性。方法:选择射频治疗肝癌患者60例,随机分为瑞芬太尼复合异丙酚(R组)组与芬太尼复合异丙酚(F组)组,每组各30例。R组用微量泵输注瑞芬太尼0.1μg·kg-1·min-1,F组单次静注芬太尼1.5μg·kg-1,两组均以异丙酚微量泵维持麻醉。使用UT4000型床边监护仪记录术前、手术开始时、手术开始后5min及患者术后苏醒时的平均动脉压、心率、脉搏氧饱和度及呼吸频率,监测动脉血二氧化碳分压;记录患者苏醒时间;记录术中体动、呼吸暂停、胸肌强直次数。结果:R组患者的清醒时间[(5.0±1.8)min]显著短于F组[(10.7±3.0)min](P<0.001)。异丙酚用量R组[(172.0±37.3)mg]显著少于F组[(330.3±61.2)mg](P<0.001)。术中R组的平均动脉压下降明显低于F组(P<0.05)。术中体动R组(5例)少于F组(12例),呼吸暂停R组(12例)多于F组(6例)。两组均未见胸肌强直。结论:肝癌射频消融术中应用微量泵静脉输注瑞芬太尼复合异丙酚麻醉效果确切、安全,但需要加强呼吸循环监护与管理。BACKGROUND ＆ OBJECTIVE： Percutaneous radiofrequency ablation （PRFA） is a new and effective microinvasive operation for small hepatocellular carcinoma, but the effectof local anesthesia or single analgesic injection as regular anesthesia is unsatisfied, This study was to evaluate the efficacy and safety of continuous intravenous infusion of remifentanyl combined with propofol as total intravenous anesthesia during PRFA, METHODS. Sixty patients scheduled for PRFA were randomized into remifentanyl group （R） and fentanyl group iF）, Each group contained 30 patients, Group R received remifentanyl infusion at the dose of 0.1 μg·kg^-1.min^-1 by micro pump; group F received bolus intravenous injection of fentanyl at 1.5 μg·kg^-1 before operation, Anesthesia was maintained with propofol, The mean arterial pressure （MAP）, heart rate （HR）, pulse oxygen saturation （SPO2）, respiration rate （RR）, partial pressure of carbon dioxide in artery （PaCO2） and recovery time were measured and recorded by monitor. The limb movement, apnea, body movements, and chest wall rigidity were recorded during operation, RESULTS, The recovery time of group R was significantly shorter than that of group F [（5.0±1.8） min vs. （10.7±3.0） min, P〈0.001]; the total consumption of propofol was less in group R than in group F [（172.0±37.3） mg vs, （330.3± 61.2） mg, P〈0.001], Group R had less cases with limb movement （5 cases vs. 12 cases） but more cases with apnea （12 cases vs. 6 patients） as compared with group F. CONCLUSIONS： Total intravenous anesthesia with remifentanyl and propofol for PRFA is safe and reliable. Respiratory depression should be monitored instantly and strictly.

关 键 词：肝肿瘤 静脉麻醉 射频消融术 瑞芬太尼 异丙酚 

分 类 号：R735.7[医药卫生—肿瘤]