地氟烷或丙泊酚联合瑞芬太尼在脊柱侧弯矫形术唤醒试验中的应用比较  

A comparision between desflurane-remifentanil and propofol-remifentanil anesthesia for scoliosis surgery with intraoperative wake-up test

作　　者：张东[1] 汪祉霖 谭文斐[1] 崔湧[1] ZHANG Dong;WANG Zhi- lin;TAN Wen- fei;CUI Yong(Department of Anesthesiology,the First Affiliated Hospital of China Medical University,Shenyang LIAONING110001,China)

机构地区：[1]中国医科大学附属第一医院麻醉科

出　　处：《中国新药与临床杂志》2019年第8期482-485,共4页Chinese Journal of New Drugs and Clinical Remedies

基　　金：辽宁省自然科学基金项目（20180551176）

摘　　要：目的比较地氟烷或丙泊酚联合瑞芬太尼在脊柱侧弯矫形术唤醒试验中的应用效果。方法选择择期行脊柱侧弯矫形术患者60例,随机分为2组,每组30例。试验组麻醉诱导后吸入麻醉维持地氟烷呼气末浓度6%~8%,对照组靶控输注丙泊酚维持血浆浓度2~4μg·mL^-1,2组均持续输注瑞芬太尼0.2~0.5μg·kg^-1·min^-1。开始行唤醒试验时试验组停止吸入地氟烷,对照组停止输注丙泊酚,2组瑞芬太尼泵速均减至0.05μg·kg^-1·min^-1。监测患者平均动脉压(MAP)、心率(HR)和脑电双频指数(BIS)值,观察并记录唤醒时间(停用麻醉药物至患者完成指令的时间)、不良反应的发生情况,评估唤醒质量评分。结果与麻醉诱导前比较,2组唤醒前、结束时患者的MAP和HR均显著降低(P<0.05)。唤醒前和唤醒时,试验组MAP显著低于对照组(P<0.05);各观察时点,2组HR均无显著差异(P>0.05)。与对照组比较,试验组唤醒时间显著缩短(P<0.05),唤醒质量评分显著降低(P<0.05)。唤醒时试验组BIS值显著高于对照组(P>0.05),2组均无严重不良反应发生。结论与丙泊酚联合瑞芬太尼相比,地氟烷联合瑞芬太尼在脊柱侧弯矫形术唤醒试验中应用,患者唤醒更快,血流动力学更平稳,且较安全。AIM To compare the effect of desflurane-remifentanil and propofol-remifentanil anesthesia for scoliosis surgery with intraoperative wake-up test.METHODS Sixty patients undergoing elective scoliosis surgery were randomly divided into two groups to receive the desflurane-remifentanil anesthesia(trial group,n=30)or propofol-remifentanil anesthesia(control group,n=30).In the trial group,anesthesia was maintained with desflurane(end-tidal 6%-8%).In the control group,anesthesia was maintained with propofol(plasma concentration 2-4μg·mL^-1)continuous infusion.Remifentanil infusion of 0.2-0.5μg·kg^-1·min^-1 was administered for both groups.When the wake-up test begun,either desflurane or propofol infusion was terminated.The infusion rate of remifentanil was reduced to a plasma concentration of 0.05μg·kg-1·min-1.Mean arterial pressure(MAP),heart rate(HR),and bispectral index(BIS)were observed,and the wake-up test time,arousal quality and adverse reactions were recorded.RESULTS Compared with those before anesthesia induction,MAP and HR were decreased significantly before and after the wake-up test(P<0.05).The MAP before and during wake-up test in the trial group was lower than that in the control group(P<0.05).There was no significant difference in HR at each point between two groups(P>0.05).Compared with the control group,the wake-up time was significantly shorter and the quality of wake-up test was improved obviously in the trial group(P<0.05).The BIS value during wake-up test in the trial group was higher than that in the control group(P<0.05).No serious adverse reaction occurred.CONCLUSION Compared with propofol-remifentanil anesthesia,desflurane-remifentanil anesthesia can provide significantly shorter onset time,improve wake-up test quality,and maintain hemodynamic stability for scoliosis surgery with intraoperative wake-up test.

关 键 词：地氟烷 丙泊酚 脊柱侧凸 脊柱侧弯矫形术 唤醒试验 

分 类 号：R971[医药卫生—药品]