雷米芬太尼复合丙泊酚麻醉在电视胸腔镜手术病人的应用

Comparison of total intravenous anesthesia with propofol-remifentanil versus fentanyl in patients undergoing video-assisted thoracoscopic surgery

目的评价雷米芬太尼复合丙泊酚全凭静脉麻醉在电视胸腔镜手术(VATS)中的麻醉效果。方法ASAⅠ～Ⅱ级于电视胸腔镜下行自发性肺大泡缝扎术病人40例,随机分为雷米芬太尼复合丙泊酚组(R组)和芬太尼复合丙泊酚组(F组),每组20例。观察麻醉诱导及气管插管时BP、HR;记录术毕停药后病人自主呼吸恢复时间、呼之睁眼时间及拔管时间;记录拔管后即刻、30min和24h疼痛视觉模拟评分(VAS);随访记录术中知晓发生率和术后恶心呕吐等副作用。结果R组插管期心血管副作用显著低于F组(P<0.05)。R组术后自主呼吸恢复时间、呼之睁眼时间及拔管时间明显短于F组(P<0.05)。R组拔管后即刻、30min的VAS高于F组(P<0.05)。两组病人均未出现术中知晓,术后的恶心呕吐发生率差异无显著意义。结论雷米芬太尼复合丙泊酚全凭静脉麻醉可安全、有效地应用于电视胸腔镜下自发性肺大泡缝扎术。雷米芬太尼半衰期短,需提前实施术后镇痛。

Objective To compare the induction of and emergence from total intravenous anesthesia（TIVA） with propofol-remifentanil/fentanyl in video-assisted thoracoscopic surgery（VATS）. Methods Forty ASA Ⅰ- Ⅱ patients scheduled for elective VATS were randomly divided into propofol-remifentanil group（group R,n= 20） and propofol-fentanyl group（group F,n=20）. The changes in BP and HR during induction and tracheal intubation, recovery of spontaneous breathing after termination of anesthesia and postoperative pain and complications were recorded and compared between two groups. Results （1）During induction,BP and HR were similar for two groups. The incidence of intubation response was lower in group R than that in group F. （2）The duration from stopping anesthetic infusion to recovery of spontaneous breathing, eye opening at request and tracheal extubation were shorter in group R than those in group F. （3）VAS after extubation was significantly higher in group R than that in group F. There was no awareness during surgery among these patients. There was no significant difference in the incidence of postoperative nausea and vomiting between two groups. Conclusion The application of TIVA with propofol-remifentanil is safe, effective and reliable in the patients undergoing VATS. Because of the shorter context-sensitive half time of remifentanil, preemptive analgesia should be applied in time.