瑞芬太尼和芬太尼用于老年患者开胸手术麻醉的比较  

Comparison of remifentanil and fentanyl in anesthesia for aged patients undergoing thoracic surgery

作　　者：郭芳[1] 

机构地区：[1]江苏省苏北人民医院麻醉科,江苏扬州225001

出　　处：《蚌埠医学院学报》2009年第4期327-329,共3页Journal of Bengbu Medical College

摘　　要：目的：比较瑞芬太尼和芬太尼用于老年患者开胸手术麻醉时的血流动力学变化、苏醒时间和并发症发生情况。方法：选择ASAⅠ-Ⅱ级择期行开胸手术80例,随机分为瑞芬太尼组（R组,n=40）和芬太尼组（F组,n=40）。两组均予咪达唑仑0.05 mg/kg、丙泊酚2 mg/kg、维库溴铵0.1 mg/kg诱导麻醉;R组用瑞芬太尼1μg/kg,F组用芬太尼3μg/kg,待患者意识消失后,行气管插管。R组持续静脉输注瑞芬太尼0.1μg.kg-1.min-1,F组不再追加芬太尼。两组术中吸入异氟烷,间断推注维库溴铵维持。记录麻醉诱导前、插管前、插管后、切皮时、去除肋骨时、关胸、拔管前和拔管后各时点的收缩压、舒张压、心率值,观察术后呼吸恢复时间、睁眼时间、拔管时间、记录有无插管反应、肌僵、呛咳、恶心、呕吐、眩晕、寒战、躁动等不良反应。术后24 h随访患者有无术中知晓及满意度。结果：两组患者在诱导前、插管前、插管后、切皮时血压和心率差异均无统计学意义（P〉0.05）,而在去除肋骨和关胸时,R组与F组血压和心率差异有统计学意义（P〈0.05）,苏醒时间差异无统计学意义（P〉0.05）,并发症差异无统计学意义（P〉0.05）。结论：瑞芬太尼麻醉能够为老年患者开胸手术提供稳定的血流动力学状态,使患者快速苏醒,是安全、有效的。Objective：To compare the hemodynamic variation, palinesthesia time and complications in using remifentanil or fentanyl as anesthetic in elderly patients receiving thoracic surgery. Methods：Eighty ASA Ⅰ-Ⅱ elderly patients undergoing thoracic surgery were randomly divided into remifentanil group （group R, n = 40 ） and fentanyl group （group F, n = 40 ）. In addition to midazolam 0.05 mg/kg, vecuronium bromide 0.1 mg/kg and propofol 2 mg/kg, remifentanil 1 μg/kg was added to group R and fentanyl 3 μg/kg to group F. The anesthesia was maintained by isofluranee in group F and 0.1 μg·kg^-1·min^-l remifentanil in group R. The systolic blood pressure, dystolic blood pressure and heart rate before induction, before and after intubation, at the time of cutting skin, removing costal bone, closing chest, and before and after extubation were recorded. The time of respiration recovery, eye opening, extubation and some side effects were also recorded. The patients＇ consciousness during operation and satisfaction degree were surveyed 24 h after operation. Results：Systolic blood pressure, dystolic blood pressure and heart rate had no statistic differences before induction, before and after intubation and at the time of cutting skin（ P 〉 0.05 ）, but the difference was significant at the time of removing the costal bone and closing the chest （P 〈 0.05 ）. There was no statistic difference in analepsia time or complications between the two groups （P 〉 O. 05 ）. Conclusions：Remifentanil-induced anesthesia may provide stable hemodynamics for elderly patients undergoing thoracic surgery. It is safe and effective.

关 键 词：麻醉 全身 胸/外科手术 瑞芬太尼 芬太尼 血流动力学 老年病学 

分 类 号：R614.2[医药卫生—麻醉学] R655.1[医药卫生—外科学]