瑞芬太尼或芬太尼复合麻醉患者支气管粘液纤毛运输速率的比较  

Comparison of bronchial ciliary mucus transport velocity between remifentanil and fentanyl combined anesthesia in patients

作　　者：印春铭[1] 何芳[1] 林莉[2] 

机构地区：[1]中国医科大学附属第四医院麻醉科,沈阳市110032 [2]沈阳医学院附属卫校医学基础教研室

出　　处：《中华麻醉学杂志》2007年第7期585-587,共3页Chinese Journal of Anesthesiology

基　　金：辽宁省教育厅高等学校科研基金资助项目（05L562）;沈阳市科学技术计划技术创新开发研究计划项目（1053125-1-54）

摘　　要：目的比较瑞芬太尼或芬太尼复合麻醉患者支气管粘液纤毛运输的速率。方法择期行腹部手术患者40例，ASAⅠ级或Ⅱ级，随机分为2组（n=20）：瑞芬太尼组采用瑞芬太尼复合异丙酚麻醉；芬太尼组采用芬太尼复合异丙酚麻醉。2组于机械通气10、60min时，测定支气管粘液纤毛运输速率。在小儿纤维支气管镜直视下，将18号硬膜外导管插入右主支气管背部上方粘膜，通过其注射1％亚甲蓝约0．015ml，标记纤维支气管镜，记录染料注射即刻、2、4、6min时的移动距离，计算支气管粘液纤毛运输速率。结果与机械通气10min比较，机械通气60min时瑞芬太尼组支气管粘液纤毛运输速率降低（P〈0．05），芬太尼组差异无统计学意义（P〉0．05）。与芬太尼组比较，瑞芬太尼组机械通气10min时差异无统计学意义（P〉0．05），机械通气60min时支气管粘液纤毛运输速率降低（P〈0．05）。结论与芬太尼复合麻醉比较，瑞芬太尼复合麻醉患者支气管粘液纤毛运输速率降低。Objective To compare the bronchial mucus transport velocity （BTV） between remifentanil and fentanyl combined anesthesia in patients.Methods Forty ASA Ⅰ or Ⅱ patients （18 male, 22 female） aged 30-50 yr undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups （ n = 20 each）： remifentanil group （R） and fentanyl group （F）. The patients were unpremedieated. Anesthesia was induced with midazolam 0.05 mg/kg, propofol 2 mg/kg and remifentanil 2 μg/kg （in group R）/fentanyl 3 μg/kg （in group F）. Tracheal intubation was facilitated with vecuronium. Anesthesia was maintained with infusion of propofol （ 100 μg· kg^- 1·min^- 1 ） and remlfentanil （0.2 μg· kg^-1·min^-1 ） /fentanyl （ 0.04 μg· kg^- 1·min^ -1 ）. The patients were mechanically ventilated. ECG, BP, HR, SpO2, PErCO2 and nasopharyngeal temperature were monitored before and during anesthesia. BTV was measured at 10 rain and 60 rain of mechanical ventilation. An epidural catheter was inserted into right main bronchus via fibereptie bronehoseope （FOB） for children. A drop of 1% methylene blue （about 0.015 ml） was placed onto the posterior surface of the bronchial mucous membrane. The proximal margin of the dye was determined immediately and at 2, 4 and 6 rain after the application of the dye. The distances the dye travelled were measured and BTV was calculated. Results The 2 groups were comparable with respect to sex ratio, age, body weight and height. The BTV measured at 60 min of mechanical ventilation was significantly lower in group R than in group F [（6.5 ± 2.3） vs （10.0± 2.0） mm/min] . There was no significant difference in the BTV measured at 10 min of mechanical ventilation between the two groups[ （10.3 ± 2.0） vs （10.1 ± 2.1 ） mm/min ]. Conclusion Remifentanil eombined anesthesia can reduce bronchial ciliary mueus transport velocity compared with fentanyl combined anesthesia.

关 键 词：哌啶类 芬太尼 支气管 粘膜纤毛清除 

分 类 号：R686[医药卫生—骨科学]