异丙酚复合芬太尼或瑞芬太尼靶控静脉麻醉与静吸复合麻醉的比较

被引:315
作者
耿志宇
宋琳琳
许幸
吴新民
机构
[1] 北京大学第一医院麻醉科
关键词
二异丙酚; 哌啶类; 药物投与系统; 麻醉,静脉内; 麻醉,吸入;
D O I
暂无
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
目的 评价异丙酚和瑞芬太尼靶控静脉麻醉的诱导和术后苏醒过程。方法 ASA Ⅰ-Ⅱ级择期行腹腔镜胆囊切除手术的病人60例,年龄<65岁,随机分为静吸复合麻醉(C)组、异丙酚瑞芬太尼靶控(R)组及异丙酚芬太尼靶控(F)组,每组20例。观察麻醉诱导及气管插管时的血压、心率;记录术毕停药后病人自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间和离开恢复室时间;观察病人拔管后即刻、离开恢复室、拔管后1、3和24h的意识状态(OAAS),认知功能测试(MMSE),疼痛评分(VRS)及主诉需要阿片药镇痛的时间;观察恶心呕吐等副反应,记录术中知晓的发生率和病人满意度等。结果 ①C组诱导时的舒张压低于R组和F组,低血压者多于R组,插管反应发生率高于R组。F组的插管反应发生率高于R组。②三组病人术后自主呼吸恢复时间、呼之睁眼时间、拔管时间差异无显著性,但F组的定向力恢复时间和离开术后恢复室(PACU)的时间早于C组。F组病人在拔管后即刻、离开PACU时、拔管后1h和3h的OAAS评分高于C组,R组病人离开PACU时的OAAS评分高于C组。F组病人拔管后1h的MMSE评分高于C组。R组病人在拔管后即刻、离开PACU时、拔管后1h和术后24h的VBS评分高于C组和F组,需要阿片药镇痛者R组多于其他两组。三组病人术后的恶心呕吐发生率差异无显著性。结
引用
收藏
页码:15 / 18
页数:4
相关论文
共 8 条
[1]  
Does functional ability in the postoperative period differ between remifentanil and fentanyl-based anesthesia. Fleisher LA,Hogue S,Colopy M,et al. Journal of Clinical Anesthesia . 2001
[2]  
Educational considerationg for the clinical introduction and use of remifentanil. Reves JG. Anesthesia and Analgesia . 1999
[3]  
Pharmacokinetics concepts for TCI anaesthesia. Cepts E. Anaesthesia . 1998
[4]  
The meaning of cognitive impairment in the elderly. Folstein M,Anthony JC,Parhad L,et al. Journal of the American Geriatrics Society . 1985
[5]  
Propofol anesthesia and rational opioid selection. Vuyk J,Mertens MJ,Olofsen E,et al. Anesthesiology . 1997
[6]  
A randomized, double-blinded study of remifentanil versus fentanyl for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients. Davis PJ,Finkel JC,Orr RJ,et al. Anesthesia and Analgesia . 2000
[7]  
Recovery and neurological examination after remifentanil-desflurane or fentanyl-desflurane anaesthesia for carotid artery surgery. Wilhelm W,Schlaich N,Harrer J,et al. British Journal of Anaesthesia . 2001
[8]  
A review of the pharmacokinetics and pharmacodynamics of remifentanil. Glass PSA,Gan TJ,Howell S. Anesthesia and Analgesia . 1999