靶控输注舒芬太尼与瑞芬太尼复合吸入麻醉对手术患者血流动力学及术后恢复情况的比较  

A comparison of remifentanil versus sufentanil with target-controlled infusion in combined inhalation anesthesia for surgical patients：effects on hemodynamics and postoperative recovery

作　　者：杨雪媛[1] 许幸[1] 吴新民[1] 

机构地区：[1]北京大学第一医院麻醉科,100034

出　　处：《中华医学杂志》2011年第12期828-831,共4页National Medical Journal of China

摘　　要：目的 比较靶控输注舒芬太尼与瑞芬太尼复合吸入麻醉对手术患者血流动力学及术后恢复情况的影响.方法 北京大学第一医院2008年1-7月40例择期全麻手术患者,美国麻醉医师协会分级Ⅰ～Ⅱ级,年龄18～65岁,体质指数（BMI）＜30.经医院伦理委员会审核,选用数字随机法随机分为瑞芬太尼组（R组）和舒芬太尼组（S组）,每组20例,R组靶控输注瑞芬太尼（血浆靶浓度为3 ng/ml）复合0.9最低肺泡有效浓度（MAC）的吸入麻醉药;S组靶控输注舒芬太尼（血浆靶浓度为0.3 ng/ml）复合0.9最低肺泡有效浓度（MAC）的吸入麻醉药.瑞芬太尼在手术结束时停药,舒芬太尼在手术结束前40～60 min停止输注.记录麻醉中血压、心率及术后呼吸恢复时间、拔管时间,观察术后疼痛情况及呼吸抑制情况.结果 麻醉后两组患者的血压、心率均显著低于术前基础值（P＜0.05）,但是都还在基础值±30%范围内;两组间血压差异无统计学意义,R组全麻诱导后,气管插管后,切皮时,手术结束以及气管拔管时的心率低于S组（P＜0.05）.R组呼吸恢复时间及拔管时间均显著短于S组[（1.8±1.4）min比（2.9±1.5）min,P＜0.05;（6.8±3.9）min比（9.1±2.8）min,P＜0.05].R组有7例患者术后视觉模拟评分（VAS）≥4,需要吗啡补救镇痛治疗.结论 靶控输注舒芬太尼或瑞芬太尼复合吸入麻醉,对血流动力学的影响是相似的;瑞芬太尼麻醉的患者术后呼吸恢复更快,拔管更早,但应及早给予镇痛治疗.Objective To compare the effect of remifentanil versus sufentanil with target-controlled infusion in combination with inhalation anesthesia for surgical patients on the parameters of hemodynamics and postoperative recovery.Methods Forty ASA Ⅰ - Ⅱ patients aged 18 -65 years old with BMI （body mass index） 〈 30,undergoing colectomy or pedical screw interfix were enrolled.Upon the approval of institutional Ethics Committee,they were randomized to receive remifentanil or sufentanil at a target plasma concentration of 3 ng/ml and 0.3 ng/ml respectively in combination of inhalated anesthesia at 0.9 MAC （minimal alveolar concentration）.The infusion of remifentanil was discontinued at the end of surgery while the infusion of sufentanil at 40 -60 minutes before the end of surgery.The arterial blood pressure（ ABP）,heart rate （HR）,electrocardiogram （ECG）and pulse blood oxygen saturation during anesthesia were monitored.The time between the termination of anesthetic use and recovery of spontaneous breathing and extubation were observed.And the incidence of postoperative pain and respiratory depression were recorded.Results As compared with the baseline values,BP and HR decreased significantly in both groups.BP was similar in both groups whereas HR was lower in Group R than that in Group S at post-induction,postintubation,incision,the end of surgery and extubation （ P 〈 0.05 ）.The time from termination of anesthesia to recovery of spontaneous breathing was 1.8 ± 1.4 min in Group R.And it was significantly shorter than that in Group S（2.9 ± 1.5 min） （P 〈0.05）.The time from termination of anesthetic use to extubation was 6.8 ±3.9 min in Group R.And it was also significantly shorter than that in Group S（9.1 ±2.8 min） （P〈0.05）.Seven patients experienced postoperative pain with visual analogue scale （VAS） 〉4.And morphine was used for rescue analgesia in recovery room.Conclusion When combined with inhalation anesthesia,the effects on hemodynamics are similar between the p

关 键 词：舒芬太尼 瑞芬太尼 吸入麻醉 血压 呼吸 

分 类 号：R614[医药卫生—麻醉学]