瑞芬太尼复合异丙酚静脉麻醉在脊柱手术中的临床观察迟疑.doc

瑞芬太尼复合异丙酚静脉麻醉在脊柱手术中的临床观察 【摘要】 目的 通过随机分组的对比观察，评价瑞芬太尼复合异丙酚静脉全麻的临床效果及安全性。方法 50例择期手术患者分为瑞芬太尼组（R组）和芬太尼组（F组），每组各25例，诱导采用咪唑安定0.04～0.05mg/kg，R组：瑞芬太尼1～2μg/kg，维库溴铵0.1～0.2mg/kg，异丙酚1～2mg/kg。F组：芬太尼2～2.5μg/kg，维库溴铵0.1～0.2mg/kg，异丙酚1～2mg/kg。维持分别为瑞芬太尼10μg/(kg ·h)，异丙酚1～3mg/(kg ·h)泵输维持；芬太尼1μg/(kg·h)，异丙酚1～3mg/(kg·h)泵输。同时吸入66%氧化亚氮和1%异氟醚，MAC保持在0.8～1.5之间。观察的指标有诱导前、插管前、插管期间、切皮前、切皮后5min以及术中每10min的血压、心率变化情况。停药后自主呼吸恢复时间、拔管时间和唤之睁眼时间；自主呼吸的潮气量、频率和ETCO2；拔管后即刻、15min、30min的意识状态（OAAS）和疼痛程度（VAS）；苏醒期间出现寒战、肌颤、恶心、呕吐及躁动等不良反应的情况。结果 与芬太尼相比，瑞芬太尼起效快、清除快、呼吸和意识的恢复优于芬太尼，镇痛效果不弱于芬太尼，安全性与芬太尼相似。结论 瑞芬太尼是一种适合用于持续输注的新型阿片类镇痛药，可用于与异丙酚复合的静脉全麻中。 【关键词】 瑞芬太尼；芬太尼；复合麻醉 Clinical observation of remifentanil combining propofol anesthesia in spinal surgery 【Abstract】 Objective To evaluate the efficacy and security of remifentanil in combine with propofol anesthesia by random grouping experiment.Methods Fifty ASA I～II patients (male 28,female 22) aged 18～65 years, weighting 55～85 kg undergoing elective cervical vertebra or lumbar vertebra internal fixation operation were randomly divided into two groups: remifentanyl group (n=25) and fentanyl group (n=25).Anesthesia was induced with midazolam 0.04 mg/kg，propofol 1～2 mg/kg,fentanyl 2～2.5μg/kg (fentanyl group) or remifentanil 1～2μg/kg(remifentanil group) and vecurnium 0.1 mg/kg and maintained with continuous infusion of fentanyl 1μg/（kg·h）(fentanyl group) or remifentanil 10μg/（kg·h）(remifentanil group) and propofol 1～3μg/（kg·h）.Inhalation anesthesia with 66% N2O and 1% isoflurane.MAC was maintained at 0.8～1.2.BP and HR were recorded before anesthesia,before intubation，after intubation，before skin cutting,5 min after skin cut and each 10 min during operation.The time of spontaneously respiration recovery，extubation and eye-open after evoking ;the VT frequency(f) and PETCO2of automatic respiration ;the OAAS and VAS after 15 min and 30 min after extubation; the incidence of shivering, amyostasia, nausea, vomiting and restlessness were recorded.Results The c