瑞芬太尼在经蝶垂体瘤手术中的应用  

The Application of Remifentanil in Transsphenoidal Surgery

作　　者：苏海荣[1] 刘静[1] 邹瑾[1] 

机构地区：[1]大连市中心医院,大连116033

出　　处：《中国现代医生》2009年第18期181-183,共3页China Modern Doctor

摘　　要：目的前瞻性预期研究中,我们评估瑞芬太尼在ASAⅠ～Ⅱ级患者行经蝶垂体瘤手术中的作用。方法麻醉诱导后,患者随机化分为异氟醚组(n=11)或瑞芬太尼组(n=12),异氟醚组异氟醚呼气末浓度2%,瑞芬太尼组异氟醚组呼气末浓度0.5%,瑞芬太尼最大用量2μg(/kg.min)。如果应用最大剂量异氟醚或瑞芬太尼后,平均动脉压>80mmHg,应用艾司洛尔。麻醉结束后记录拔管时间、清醒时间、呼吸频率、SpO2、MAP、心率和副作用。结果在组内比较血流动力学,出血量(小量,少量,中量,严重)没有差异。异氟醚组7个患者应用艾司洛尔,瑞芬太尼组3例患者应用艾司洛尔(P<0.01)。异氟醚组艾司洛尔应用剂量大([1.1±0.7)mg/kg:(0.4±0.5)mg/kg,P<0.05]。拔管时间没有差异,而瑞芬太尼组按照指令动作时间短([16±7)min:(10±1)min,P<0.01]。术后早期没有不良反应发生。结论经蝶垂体瘤微创手术应用瑞芬太尼复合麻醉血流动力学稳定,快速苏醒,不存在呼吸抑制。Objective In this prospective study,we evaluated the effects of remifentanil in ASA Ⅰ - Ⅱ patients undergoing transsphenoidal surgery. Methods After the induction of anesthesia,patients were randomly allocated to the Isoflurane（n=11,isoflurane up to 2% endtidal） or Remifentanil group（n=12,0.5% end-tidal isoflurane,remifentanil up to 2μg/（kg·min））. If mean arterial pressure （MAP）increased〉8OmmHg during maximal dosage of isoflurane or remifentanil,esmolol was administered.At the end of anesthesia, extubation and awakening times,respiratory rate , SpO2, MAP, heart rate and adverse effects were recorded. Results Hemodynamics and bleeding（minimal, mild, moderate, severe） were not different between groups. Esmolol was administered to 7 patients in the isoflurane group,and 3 patients in the remifentanil group（P〈0.01）. The dose of esmolol was larger in the isoflurane group（1.1±0.7 versus 0.4± 0.5mg/kg,P〈0.05）. Time to extubation did not differ,whereas time to follow commands was shorter in Remifentanil patients （16 ±7 versus 10 ± 1min,P〈0.01）. No adverse effects occurred in the early post-operative period. Conclusion Stable hemodynamics and the rapid emergence and the absence of postoperative respiratory depression seem to be the chief benefits from the use of balanced anesthesia with remifentanil in elective transsphenoidal surgery.

关 键 词：瑞芬太尼 异氟醚 垂体瘤 

分 类 号：R739.41[医药卫生—肿瘤]