瑞芬太尼复合丙泊酚麻醉在颅脑手术中的应用  

Application of Anaesthesia with Reminfentanil and Propofol in Craniocerebral Operations

作　　者：周志刚[1] 王北冰[2] 涂玉林[3] 胡啸玲[1] 

机构地区：[1]南华大学第一附属医院麻醉科,湖南衡阳421001 [2]南华大学诊断学教研室 [3]南华大学心血管病研究所

出　　处：《南华大学学报（医学版）》2008年第1期60-62,66,共4页Journal of Nanhua University(Medical Edition)

基　　金：湖南省教育厅课题(04C581)

摘　　要：目的探讨瑞芬太尼复合丙泊酚在颅脑手术麻醉中应用的临床价值。方法120例ASA I～Ⅲ级在全麻下择期手术患者，随机分为瑞芬太尼组和芬太尼组，麻醉诱导静注咪唑安定＋维库溴铵＋依托咪酯＋瑞芬太尼（或芬太尼），麻醉维持采用持续泵注瑞芬太尼（或芬太尼）＋丙泊酚。观察并记录两组患者入手术室时、插管前即刻、插管后1min、插管后10min和拔管各个时段的血流动力学变化、麻醉恢复情况（自主呼吸恢复时间、睁眼时间和拔管时间）以及苏醒期间使用镇痛药和躁动情况。结果血流动力学变化：与基础值比较，两组均在诱导后下降，插管后lmin芬太尼组升高，瑞芬太尼组在拔管时升高。麻醉恢复情况：瑞芬太尼组早于芬太尼组；镇痛药使用瑞芬太尼组多于芬太尼组；瑞芬太尼组患者躁动少于芬太尼组。结论瑞芬太尼相对于芬太尼用于颅脑手术中全身麻醉更具优势，其麻醉平稳、血流动力学稳定、苏醒快、完全，有利于早期拔管。由于药物代谢快，疼痛出现早，需及时给予必要的术后镇痛。Objective To investigate clinical value of reminfentanil and propofol in craniocerebral operations. Methods 120 cases of patients in ASA degree I - Ⅲ, which need endotracheal anesthesia in operating, were at random divided into two groups ： the reminfentanil group and the fentanyl group. Induction of anesthesia was used by intravenous injection with midazolam, vecuronium, etomidate and reminfentanil （or fentanyl）, and maintenance of anesthesia was kept by pouring with reminfentanil （or fentanyl） and propofol. Changes of haemodynamics and anes- thesia palinesthesia （including pain- killer usage） were observed and recorded continuously during every period of operahon Results Changes of haemodsaaamics shew after induction BP and HR of the two groups were both lower than the baseline. While 1 minute after intubatlng the data of the fentanyl group were higher than baseline, after extubating the data of the reminfentanil group were significanly higher than baseline. Anesthesia palinesthesia time were shorter in the reminfentanil group than in the fentanyl group. There were more usage of pain - killer and fewer restlessness in the reminfentanil group. Conclusion Reminfentanil could be more efficient than fentanyl in endotracheal anesthesia of craniocerebral operations, including stable efficiency, fast metabolism and profit to early extubation and analepsia.

关 键 词：瑞芬太尼 芬太尼 丙泊酚 颅脑手术 血流动力学 苏醒期 

分 类 号：R614.2[医药卫生—麻醉学]