术终芬太尼对异丙酚-瑞芬太尼静脉麻醉苏醒期的影响  

Effects of Post-operative Fentanyl Administration on Revival Profiles of Propofol-remifentannil Anesthesia

作　　者：黄卫[1] 柴云飞[1] 俞润英[2] 王建珍[3] 

机构地区：[1]广东省心血管病研究所麻醉科,广东广州510100 [2]广东省人民医院手术室,广东广州510080 [3]宁夏医学院附属医院麻醉科,宁夏银川750004

出　　处：《中山大学学报（医学科学版）》2008年第5期598-601,610,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科学基金(A2008053)

摘　　要：【目的】探讨术终静脉注射芬太尼1.5μg/kg对异丙酚-瑞芬太尼静脉麻醉苏醒过程的影响。【方法】ASAⅠ～Ⅱ级,年龄18～65岁,在异丙酚-瑞芬太尼静脉复合全麻下行择期手术的病人80例,随机分为负荷剂量组和对照组,每组40例。术终瑞芬太尼停药时,负荷剂量组静脉注射芬太尼1.5μg/kg后续以静脉自控镇痛,对照组静脉注射等容量的生理盐水后开始静脉自控镇痛。比较两组病人麻醉苏醒期的血流动力学、麻醉苏醒、术后疼痛、以及不良反应等情况。【结果】两组病人的一般情况、麻醉苏醒过程、以及不良反应发生率等观察指标组间比较差异均无统计学意义(P>0.05);拔管后10min和拔管后30min时VAS评分≥2分的病例数:对照组分别为22例(65%)和30例(75%)、负荷剂量组分别为8例(20%)和6例(15%),组间比较差异有统计学意义(P<0.05);从呼之睁眼到拔管后30min各时点的动脉收缩压和心率对照组明显高于负荷剂量组(P<0.05)。【结论】术终静脉注射芬太尼(1.5μg/kg)不影响瑞芬太尼-异丙酚静脉麻醉的苏醒过程。[Objective] To study the effects of post-operative intravenous administration of fentanyl （0.15 μg/ kg） on the revival profiles of propofol-remifentannil based intravenous anesthesia. [Methods] Eighty patients were allocated into 2 groups： Bolus-dose group （B-group） and Control group （C-group）. At the end-point of remifentannil infusion, a bolus dose of fentanyl （0.15 μg/kg） was injected intravenously in the B-group while the same volume of normal saline （NS） was administered in the C-group. Then, a fentanyl-based IVPCA were started in both of the two groups. The revival profiles of anesthesia （the time to eye-opening, the time to revival of spontaneous breathing, and the time to extubation）, the changes in haemodynamics and the incidence rate of acute pain during the revival period were observed and compared. [Results] There were no differences in the revival profiles of anesthesia between the two groups ; the systolic arterial pressure and heart rate at the time points of eyeopening, 10 min and 30 min after extubation were significantly higher in the C-group than in the B-group （P 〈 0.05）; the incidences of the moderate to severe pain （with a VSA score≥2） at the 10 min and 30 min after extubation were significantly higher in the C-group than in the B-group （P 〈 0.05）. [Conclusions] Post-operative administration of a bolus dose of fentanyl 0.15 μg/kg can effectively enhance the quality of post-operative pain management and doesn＇t affect the revival profiles of propofol-remifentannil based intravenous anesthesia.

关 键 词：芬太尼 瑞芬太尼 异丙酚 麻醉苏醒 术后镇痛 

分 类 号：R614.24[医药卫生—麻醉学]