瑞芬太尼和芬太尼复合丙泊酚靶控输注在神经外科手术中的应用  

Remifentanil and fentany combined with propofol administered by target controlled infusion in neurosurgery

作　　者：白念岳[1] 郭曲练[1] 程智刚[1] 王月玲[1] 杨胜辉[1] 

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008

出　　处：《中南大学学报（医学版）》2009年第1期59-62,共4页Journal of Central South University ：Medical Science

摘　　要：目的:比较瑞芬太尼复合丙泊酚靶控输注和芬太尼持续泵注复合丙泊酚靶控输注全静脉麻醉在神经外科手术中的血流动力学变化和麻醉后恢复情况。方法:将神经外科择期手术患者80例随机分为瑞芬太尼组(R组,n=40)和芬太尼组(F组,n=40)。R组采用血浆靶控输注瑞芬太尼和丙泊酚,靶控浓度分别为3～5μg/L和3～5mg/L;F组持续泵入芬太尼2～3μg/(kg.h),丙泊酚靶控浓度同R组,术中间断追加维库溴铵维持肌松。记录麻醉过程中血压、心率的变化,并观察手术后患者的恢复情况。结果:所有患者麻醉诱导后至手术结束时的平均动脉压与诱导前比较均明显下降(P<0.01)。R组呼吸恢复后至拔管时的心率较诱导前明显加快(P<0.01),F组上头架后至手术结束心率较诱导前明显减慢(P<0.01),停药后恢复。两组间血压、心率比较无明显差别(P>0.05),R组患者呼之睁眼的时间和拔管时间明显缩短,疼痛评分明显升高(P<0.01)。结论:在神经外科手术中应用瑞芬太尼和芬太尼复合丙泊酚靶控输注全静脉麻醉均能提供稳定的血流动力学状态,瑞芬太尼靶控输注苏醒更迅速,但疼痛评分高于芬太尼组。Objective To compare the hemodynamics and post-anesthetic recovery of total intravenous anesthesia （TIVA）with remifentanil or fentanyl combined with propofol administered by target controlled infusion （ TCI ） in neurosurgy. Methods A total of 80 patients undergoing selective neurosurgy were randomly divided into a remifentanil group （ Group R, n = 40 ） and a fentanyl group （Group F, n = 40 ）. In Group R, remifentanil and propofol was administered by TCI and the blood concentration were 3 -5 μg/L and 3 -5 mg/L each. In Group F, fentanyl was continuously infused at 2 - 3 μg/（ kg·h ） and propofol was administered by TCI with the same blood concentration as that in Group R. Vecuronium was injected at intervals to maintain muscle relaxant. Mean arterial pressure and heart rate during the anesthesia and post-anesthetic recovery were recorded. Results Mean arterial pressure of all the patients was decreased significantly from induction of anesthesia to termination of operation compared with that before the induction （P 〈 0.01 ）. The heart rate of Group R was increased obviously from recovery of respiration to extubation and heart rate of Group F was decreased obviously from fixed headframe to termination of operation compared with that before the induction （ P 〈 0.01 ）. But there was no significant difference between the 2 groups （ P 〉 0.05 ）. The eyes opened and extubed time of Group R were decurtated obviously and the scores of pain were increased significantly （ P 〈 0.01 ）. Conclusion TIVA with remifentanil or fentanyl combained with propofol administered by TCI in neurosurgical operation can provided steadible hemodynamics. Resuscitation of remifentanil with propofol administered by target controlled infusion were more quickly but the scores of pain were more higher than that of fentanyl.

关 键 词：瑞芬太尼 芬太尼 丙泊酚 靶控输注 静脉麻醉 神经外科 

分 类 号：R614.24[医药卫生—麻醉学]