TCI舒芬太尼和瑞芬太尼复合麻醉用于腹腔镜下结直肠癌根治术病人麻醉恢复质量的比较  

A comparison of quality of emergence from TCI of sufentanii versus remifentanil supplementing propofolsevoflurane anesthesia in patients undergoing radical colo-rectal cancer resection

作　　者：何万友[1] 王汉兵[2] 杨承祥[2] 周俊[2] 郑雪琴[1] 

机构地区：[1]徐州医学院江苏省麻醉学重点实验室,221002 [2]佛山市第一人民医院麻醉科

出　　处：《中华麻醉学杂志》2012年第4期447-450,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较TCI舒芬太尼和瑞芬太尼复合麻醉用于腹腔镜下结直肠癌根治术病人的麻醉恢复质量。方法择期行腹腔镜下结直肠癌根治术病人40例，年龄40—64岁，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将病人随机分为2组（n=20）：TCI瑞芬太尼复合麻醉组（R组）和TCI舒芬太尼复合麻醉组（S组）。麻醉诱导：静脉注射阿托品0．25mg，TCI异丙酚和瑞芬太尼（或舒芬太尼），异丙酚血浆靶浓度（cp）为4．0μg/ml，瑞芬太尼cp为4．0ng/ml，舒芬太尼效应室靶浓度（Ce）为0．4ng／ml，静脉注射维库溴铵0．1mg／kg，气管插管后机械通气。麻醉维持：TCI异丙酚，瑞芬太尼cp和舒芬太尼ce分别为2．5、0．25ng/ml，间断静脉注射维库溴铵0．03ms／ks，调节异丙酚Cp和七氟醚浓度，维持Norcotrend指数37-56。记录苏醒时间、拔除气管导管时间和麻醉恢复期不良事件的发生情况。结果与R组比较，S组苏醒时间和拔除气管导管时间延长，但是高血压、心动过速、呛咳、躁动和寒颤的发生率降低（P〈0．05）；2组均无一例病人发生苏醒延迟或呼吸抑制。结论与TCI瑞芬太尼复合麻醉比较，TCI舒芬太尼复合麻醉用于腹腔镜下结直肠癌根治术病人麻醉恢复质量较高。Objective To compare the quality of emergence from TCI of sufentanil and remifentanil sup- plementing propofol-sevoflurane anesthesia in patients undergoing radical colo-rectal cancer resection. Methods Forty ASA I or II patients of both sexes aged 40-64 yr undergoing elective radical colo-rectal cancer resection were allocated into 2 groups （ n = 20 each） ： sufentanil group （group S） and remifentanil group （group R）. Anes- thesia was induced with propofol TCI at plasma concentration （Cp） of 4.0 μg/ml in both groups and sufentanil TCI （effect-site concentration Ce = 0.4 ng/ml） or remifentanil TCI （Cp = 4.0 ng/ml）. Tracheal intubation was facilitated with vecuronium 0.1 mg/kg. The patients were mechanically ventilated （VT = 8-10 ml/kg, PER = 12-16 bpm）. PETCO2 Was maintained at 30-40 mm Hg. Anesthesia was maintained with propofol TCI-sevoflurane supplemented with sufentanil （Ce = 0.25 ng/ml） or remifentanil （Cp = 2.5 ng/ml）. The depth of anesthesia was maintained at Narcotrend index of 37-56 by adjusting Cp of propofol TCI and sevoflurane concentration. The infusion of sufentanil was discontinued at 40 min before the conclusion of the operation while remifentanil was administered until the end of surgery. The incidence of postoperative adverse events, the time from the end of operation to eye opening and the time to extubation were recorded. Results The two groups were comparable with respect to demographic data. Neither group developed prolonged emergence and respiratory depression but the time from the end of operation to eye opening and the time to extubation were significantly Xonger in group S than in group R. The incidence of hypertension and tachycardia, agitation, shivering and coughing were significantly lower in group S than in group R. Conclusion The quality of emergence from sufentanil supplementing propofol-sevoflurane anesthesia is higher than that from remifentanil.

关 键 词：舒芬太尼 哌啶类 药物释放系统 麻醉恢复期 恢复质量 

分 类 号：R614[医药卫生—麻醉学]