瑞芬太尼-异丙酚全凭静脉麻醉对FESS手术应激反应及麻醉复苏的影响  

Effect of Total Intravenous Anesthesia with Propofol-remifentanil on Stress Reaction and Anesthetic Recovery for Patients with Functional Endoscopic Sinus Surgery

作　　者：纪风涛[1] 曹铭辉[1] 王志[1] 梁建军[1] 苗利萍[1] 吴强[1] 李珏[1] 

机构地区：[1]中山大学附属第二医院麻醉科,广东广州510120

出　　处：《中山大学学报（医学科学版）》2010年第6期895-897,共3页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(7001595);广东省科技计划项目(2010B080701004)

摘　　要：【目的】评价异丙酚复合瑞芬太尼全凭静脉麻醉对鼻内镜(FESS)手术应激反应及麻醉复苏的影响。【方法】ASAⅠ～Ⅱ级择期行FESS手术病人60例,年龄23～57岁,随机分为静吸复合麻醉组(A组)和异丙酚瑞芬太尼麻醉组(B组),每组30例。检测术中不同时点血浆皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)、促肾上腺皮质激素(ACTH)浓度并观察平均动脉压(MAP)和心率(HR)的变化,记录术毕停药后拔管时间,拔管后即刻和离开术后恢复室(PACU)的意识状态(OAAS)评分以及离开PACU时间;观察恶心呕吐等不良反应并记录术中知晓的发生率。【结果】两组手术开始后各时点Cor、NE、E、ACTH浓度与术前相比均显著增高(P<0.05),A组各指标显著高于同时点B组(P<0.05);MAP和HR的变化无统计学差异(P>0.05)。B组术后拔管时间明显快于A组(P<0.05);B组在拔管后即刻及离开PACU时OAAS评分高于A组(P<0.05);B组离开PACU时间早于A组(P<0.05);两组术后恶心、呕吐发生率无统计学差异(P>0.05)。所有病人术后随访均未出现术中知晓。【结论】FESS手术使用异丙酚复合瑞芬太尼全凭静脉麻醉可有效抑制应激反应,病人苏醒质量明显改善。【Objective】 To evaluate the effects of the total intravenous anesthesia with propofol-remifentanil on stress reaction and anesthetic recovery for the patients undergoing the functional endoscopic sinus surgery （FESS）. 【Methods】 Sixty patients aged 23 to 57 years old,scheduled for selective FESS were randomly divided into two groups：Inhalation anesthesia group （group A） and propofol-remifentanil anesthesia group （Group B）,30 cases each group. To test the concentration of cortisol （Cor）,norepinephrine （NE）,epinephrine （E） and adrenocorticotrophic hormone （ACTH） at different time point and to observe the variation of mean artery pressure （MAP）,heart rate （HR） during operation. Exudation time,OAAS score at the time of leaving the post anesthetic care unit （PACU） and discharging from the surgical intensive care unit as well as the time of discharging from the surgical intensive care unit were recorded. The Side effects such as nausea and vomiting,the incidence of the intraoperative awareness were observed and recorded. 【Results】 The concentrations of Cor,NE,E,and ACTH at different point of two groups were significantly higher than those before operation. Each index in group A was higher than in group B （P 0.05）. There was no significant changes in MAP and HR between two groups （P 0.05）. The OAAS scores were higher in group B than in group A at the time of exudation and the time when the patients discharged from PACU （P 0.05）,Group B discharged from the PACU were earlier than group A （P 0.05）. There were no significant statistic difference in postoperative nausea and vomiting （P 0.05）. No intraoperative awareness was founded. 【Conclusion】 Total intravenous anesthesia with propofol-remifentanil during FESS can reduce stress response effectively and can improve the patients＇ recovery from anesthesia.

关 键 词：异丙酚 瑞芬太尼 麻醉 静脉 吸入 应激反应 鼻内窥镜手术 

分 类 号：R473.6[医药卫生—护理学]