胸科手术中瑞芬太尼联合芬太尼对应激和炎症反应的影响及临床疗效观察  

Effect of Remifentanil Combined with Fentanyl on Stress and Inflammatory Reaction in Thoracic Surgery and the Clinical Efficacy

作　　者：付学敏[1] 沈金美[2] 

机构地区：[1]湖南中医药大学第一附属医院麻醉科,湖南长沙410007 [2]中南大学湘雅二医院麻醉科,湖南长沙410011

出　　处：《医学临床研究》2011年第4期695-698,共4页Journal of Clinical Research

摘　　要：【目的】了解全程应用芬太尼与瑞芬太尼维持而于缝皮时改为单次静脉注射芬太尼两种全麻方法对胸科手术患者应激激素的影响及疗效。【方法】选择择期行胸科手术患者40例随机分为两组，全程应用芬太尼（F）组和瑞芬太尼维持且于缝皮时改为单次静脉注射芬太尼（R＋F）组，记录病人麻醉前（T0），麻醉诱导后气管插管前即刻（T1），气管插管即刻（T2），切皮后即刻（T3），开胸探查（T4）、缝皮（T5）、拔管（T6）时各项指标的变化。【结果】①两组在T0、T1、T2及T6时平均动脉压（MAP）、心率（HR）无差异（P〉0．05），而R＋F组在T3、T4及T5时前述指标均明显低于F组（P〈0．01）。②两组在T0、T1及T2时去甲肾上腺素（NE）和肾上腺素（E）的水平无统计学差异（P〉0．05）；在T3、T4、T5和T6时F＋R比F组NE及E水平明显低（P〈0．05）。③两组各时间点IL-6水平及清醒时间和拔管时间、术后伤口疼痛和烦躁情况相比较均无差异。【结论】胸科手术中持续输注瑞芬太尼可以使生命体征相对平稳，减轻应激，但对细胞因子生成无明显影响；于手术结束前缝皮时停止输注瑞芬太尼单次注射芬太尼并不影响患者麻醉苏醒，且可有效防止术后疼痛。[Objective] To compare the effect of total fentanyl infusion vs. remifentanil maintenance and then the alternative fentanyl by intravenously once While the skin closure on the stress hormones in patients undergoing thoracic surgery and the clinical efficacy. [Methods] Forty patients who were scheduled for thoracic surgery were selected and randomly assigned to 2 groups. Group R received total fentanyl infusion anesthesia. Group R-F received remifentanil maintenance intraoperatively and then turned to receive the fentanyl by intra- venously once while the skin closure. The changes of parameters were recorded before anesthesia（T0）, before intubation（T1 ）, at intubation（T2 ）, skin incision（T3 ）, exploratory thoractomy（T4 ）, skin closure（Ts ） and ex- tubation（T6）. [Results] There was no difference in mean arterial pressure（MAP） and heart rate（HR） at To, T1 , T2 and T6 between two groups（ P 〉0.05）, but those in group R＋F at T3, 74 and Ts were obviously lower than those in group F（ P 〈0.01）. There was no statistical difference in the level of norepinephrine（NE） and eprinephrine（E） at T0, T1 and T2 between two groups（ P 〉0. 05）, but those at T3 ,T4 ,Ts and T6 in group F＋R were lower than those in group F（ P 〈0.05）. There was no significant difference in IL-6, recovery time, intubation time, postoperative pain and postoperative agitation at each time points between two groups. [Conclusion] Continuous infusion of remifentanil during thoracic surgery can maintain the stability of hemodynamics and alleviate the stress response, but has no influence on the production of cytokines. One time bolus of fentanyl when skin closure before surgery after stopping the infusion of remifentanil may not delay the recovery from anesthesia, while can prevent the postoperative pain.

关 键 词：胸外科手术 芬太尼/投药和剂量 应激 炎症 

分 类 号：R655[医药卫生—外科学]