靶控输注异丙酚复合舒芬太尼或瑞芬太尼在神经外科手术中的比较  

Target-controlled infusion of propofol/sufentanil versus profofol/remifentanil in neurosurgery

作　　者：肖彬[1] 张兴安[2] 徐波[2] 邵伟栋[2] 施冲[2] 

机构地区：[1]广州市花都区人民医院麻醉科,510800 [2]广州军区广州总医院麻醉科,510010

出　　处：《实用医学杂志》2007年第20期3140-3142,共3页The Journal of Practical Medicine

基　　金：广东省科技计划项目(编号:2002C40401);广州市科研计划项目(编号:2005C13G0101)

摘　　要：目的:比较靶控输注异丙酚复合舒芬太尼或瑞芬太尼全静脉麻醉在神经外科手术中的麻醉效果以及术后麻醉恢复情况。方法:将46例神经外科择期手术病人分为两组。以血浆药物浓度为靶浓度,靶控输注舒芬太尼(PS组,n=23)0.4～0.8μg/L或瑞芬太尼(PR组,n=23)2～4μg/L后,逐步升高异丙酚靶浓度至3～4mg/L,视术中情况调整舒芬太尼或瑞芬太尼靶浓度维持麻醉平稳,观察收缩压(SBP)、舒张压(DBP)、心率(HR)以及麻醉恢复情况。结果:麻醉诱导后PS组输注异丙酚后SBP、DBP、HR下降(P<0.05);PR组病人SBP、DBP均降低(P<0.05),HR降低明显(P<0.01)。气管插管、切皮及术中血流动力学稳定。术后2hPS组病人平稳。PR组躁动发生率为13%。结论:神经外科手术中靶控输注异丙酚复合舒芬太尼或瑞芬太尼全静脉麻醉均能达到满意的麻醉效果,舒芬太尼麻醉血流动力学稳定,恢复平稳。Objective To compare the anesthetic effect of target-controlled infusion （TCI） of propofol/sufentanil with that of profofol/remifentanil and recovery of anesthesia. Methods Forty-six patients scheduled for elective neurosurgery were assigned to receive either propofol plus 0.4 to 0.8 μg/L of sufentanil （group PS, n=23）, or propofol and 2 to 4 μg/L of remifentanil （group PR, n=23）. Then the target plasma concentration of propofol increased gradually up to 3 to 4mg/L. SBP, DBP, HR and recovery of anesthesia were observed in all patients. Results SBP, DBP, and HR were decreased in PS group after induction of anesthesia and propofol infusion （P 〈 0.05）, so were SBP and DBP in PR group （P 〈 0.05） with a more significant fall in HR （P 〈 0.01）. Hemodynamics was stable during intubation and surgery. All of the patients in PS group recovered smoothly and 13% of the patients in PR group occurred restlessness 2 hours after surgery. Conclusions TCI of either propafol/snfentanil or propafol/remifentanfl achieves a satisfactory effect of anesthesia in neurosurgery. Hemodynamics is more stable and recovery of anesthesia is smoother in the use of sufentanil.

关 键 词：麻醉 静脉 二异丙酚 舒芬太尼 瑞芬太尼 靶控输注 神经外科手术 

分 类 号：R614[医药卫生—麻醉学]