瑞芬太尼静脉麻醉在老年普外科手术患者中的应用效果及对血流动力学指标的影响  

Application Effect of Remifentanil Intravenous Anesthesia in Elderly Patients Undergoing General Surgery and Its Influence on Hemodynamic Indexes

作　　者：邵静[1] 侯瑞礁 沈雷兵 SHAO Jing;HOU Ruijiao;SHEN Leibing(Department of Anesthesiology,the Ninth People′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 201900,China)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海201900

出　　处：《医学综述》2023年第12期2492-2496,共5页Medical Recapitulate

摘　　要：目的探讨瑞芬太尼静脉麻醉在老年普外科手术患者中的应用效果及对血流动力学指标的影响。方法回顾性分析2016年7月至2018年7月上海交通大学医学院附属第九人民医院收治的96例老年普外科手术患者的临床资料,依据麻醉方法不同分为两组,各48例,其中芬太尼组持续静脉注射芬太尼2.0μg/kg,瑞芬太尼组持续静脉注射瑞芬太尼1.0μg/kg,待患者丧失意识后均予以维库溴胺0.1 mg/kg。比较两组血流动力学指标(收缩压、舒张压、心率)、术后麻醉和恢复情况(手术时间、自主呼吸恢复时间、拔管时间和睁眼时间)以及并发症发生情况。结果收缩压、舒张压、心率不同时点间的主效应差异有统计学意义(P<0.01),不考虑测量时间,各指标组间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01);诱导后,两组收缩压、舒张压、心率均下降,插管后5 min、插管后10 min,瑞芬太尼组收缩压、舒张压、心率与诱导后比较无明显变化,芬太尼组收缩压、舒张压、心率均大幅升高(P<0.05);瑞芬太尼组插管后5 min与插管后10 min的收缩压、舒张压、心率低于芬太尼组(P<0.05)。两组患者手术时间比较差异无统计学意义(P>0.05),瑞芬太尼组自主呼吸恢复时间、拔管时间、睁眼时间显著低于芬太尼组[(7.2±1.1)min比(9.9±1.2)min、(13±4)min比(19±4)min、(11±3)min比(17±4)min](P<0.01)。术后瑞芬太尼组并发症总发生率低于芬太尼组[4.17%(2/48)比18.75%(9/48)](P<0.05)。结论与芬太尼相比,瑞芬太尼用于老年普外科手术效果更好,血流动力学更稳定,术后恢复更快且并发症较少。Objective To investigate the application effect of intravenous anesthesia with remifentanil in elderly patients undergoing general surgery and the effect on hemodynamic indexes.Methods The clinical data of 96 elderly patients undergoing general surgery admitted to the Ninth People′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from Jul.2016 to Jul.2018 were retrospectively analyzed,and the cases were divided into two groups of 48 patients each according to different anesthesia methods:a fentanyl group received continuous intravenous fentanyl(2.0μg/kg)and a remifentanil group received continuous intravenous remifentanil(1.0μg/kg).After the patients lost consciousness,they were both given vecuronium 0.1 mg/kg.The hemodynamic indexes(systolic blood pressure,diastolic blood pressure,heart rate),postoperative anesthesia and recovery(operative time,the recovery time of spontaneous breathing,extubation time and eye opening time),and complications of the two groups were compared.Results The main effect differences of systolic blood pressure,diastolic blood pressure and heart rate among different time points were statistically significant(P<0.01);regardless of the measurement time,the main effect difference of each index between groups was statistically significant(P<0.01),and there was interaction between groups and time points(P<0.01).After induction,systolic blood pressure,diastolic blood pressure and heart rate decreased in both groups;at 5 min and 10 min after intubation,systolic blood pressure,diastolic blood pressure and heart rate in the remifentanil group had no significant changes compared with after induction,while systolic blood pressure,diastolic blood pressure and heart rate in the fentanyl group were significantly increased(P<0.05);Systolic blood pressure,diastolic blood pressure and heart rate at 5 min and 10 min after intubation in the remifentanil group were lower than those in the fentanyl group(P<0.05).There was no statistically significant difference in the comparison of

关 键 词：静脉麻醉 瑞芬太尼 麻醉效果 血流动力学 

分 类 号：R614.24[医药卫生—麻醉学]