瑞芬太尼能够取代氧化亚氮用于地氟烷和芬太尼麻醉的门诊骨科手术吗？  

作　　者：Donald M. Mathews Vijay Gaba Bledi Zaku George G. Neuman 刘宽智(译) 刘克玄(校) 陈秉学(校) 

机构地区：[1]Department of Anesthesiology, St. Vincent Catholic Medical Centers, St. Vincent's Manhattan, and New York Medical College, Valhalla, New York [2]不详

出　　处：《麻醉与镇痛》2009年第1期55-62,共8页Anesthesia & Analgesia

摘　　要：背景手术中使用氧化亚氮（N2O）可能导致多种不良反应和毒性反应。瑞芬太尼与氧化亚氮有相似的特性，包括：降低挥发性麻醉药的MAC、镇痛以及停用后药效快速消失。我们比较了在门诊骨科手术采用地氟烷和芬太尼麻醉的患者中，添加临床等效剂量的氧化亚氮或瑞芬太尼对手术后转归的影响。方法70例行门诊骨科手术的患者入选。其中35例吸入66％的N2O，其余35例接受静脉注射0．085ug·kg^-1·min^-1的瑞芬太尼。所有患者均复合使用地氟烷并逐步增加剂量至脑电双频指数（BIS）为50，同时静脉注射芬太尼。测定的主要转归指标为患者在语言刺激下苏醒的时间，次要转归指标包括：神经心理测验、定向力恢复时间、血流动力学指标、疼痛和恶心的视觉模拟评分、出院时间以及满意度评分。此外还观察地氟烷的呼气末平均浓度和芬太尼效应室浓度。结果语言唤醒时间的中位数（四分位距）：瑞芬太尼组为3．0分钟（3．0—5．0分钟），N2O组的为4．6分钟（3．0～8．1分钟），两组间差异无统计学意义。瑞芬太尼组的定向力恢复时间为6．0分钟（5．0—8．5分钟）明显短于N2O组8．0分钟（5．0～12．8分钟）。两组患者地氟烷和芬太尼的使用剂量、神经心理测试以及其他测定的转归指标均无显著差异。结论本研究表明在地氟烷和芬太尼麻醉期间，0．085ug·kg^-1·min^-1的瑞芬太尼能够代替66％N2O，并且不改变患者的临床转归。BACKGROUND： The administration of nitrous oxide （N2O） may be associated with side effects and toxicities. Remifentanil shares characteristics with N2O, including MAC-reducing and antinociceptive effects and a rapid decrease in clinical effect when discontinued. We compared the outcome after ambulatory orthopedic surgery with desflurane and fentanyl supplemented with clinically equivalent doses of either N2O or remifentanil. METHODS： Seventy patients undergoing ambulatory orthopedic surgery were studied. Thirty-five received 66% N2O and 35 received remifentanil 0. 085ug· kg^-1·min^- 1 in addition to desflurane, titrated to a bispectral index （BIS） value of 50, and a fentanyl infusion. The principle outcome measure was time to awakening to verbal stimulation. Secondary outcome measures induded neuropsychological testing, time to orientation, hemodynamic values, pain and nausea visual analog scores, discharge times, and satisfaction scores. The average end-tidal desflurane concentration and fentanyl effect-site concentration were determined. RESULTS： The median time （interquartile range） to awakening to verbal stimulation, 3.0min （3.0 - 5.0 min） in the remifentanil group and 4. 6 min （3.0 -8. 1 min） in the N20 group was not significantly different. Median time to orientation was significantly faster in the remifentanil group： 6.0 min （5.0 -8.5 min） compared with 8.0 rain （5.0 - 12.8 min） for the N2O group. There was no difference between groups in desflurane or fentanyl administration, neuropsychological testing, or any other outcome measure. CONCLUSIONS： This study demonstrates that a remifentanil infusion of 0. 085 ug·kg^-1· min^-1 may be substituted for 66% N2O during desflurane/fentanyl anesthesia without any clinically significant change in outcome.

关 键 词：挥发性麻醉药 瑞芬太尼 氧化亚氮 骨科手术 地氟烷 门诊 手术后转归 视觉模拟评分 

分 类 号：R971.2[医药卫生—药品] R169.42[医药卫生—药学]