瑞芬太尼与芬太尼配伍在短小手术中应用的研究

Comparision of Anesthesia Effect and Recovery of Remifentanil Combined with Fentanyl under LMA in Minor Surgeries

目的探讨短小手术瑞芬太尼与芬太尼联合应用的麻醉效果、麻醉恢复及呼吸抑制问题。方法择期短小手术患者40例随机分成二组。麻醉诱导后置入喉罩。麻醉维持置喉罩后单次静脉注射芬太尼1μg.kg-1,切皮前单次静脉注射瑞芬太尼1μg.kg-1继之瑞芬太尼0.2μg.kg-1.min-1持续输注,分别复合异丙酚和异氟醚吸入。麻醉诱导和维持期间均不用肌肉松弛剂。结果芬太尼与瑞芬太尼联合使用无论是与异丙酚配伍还是和异氟醚配伍其平均动脉压和心率均维持在基础值的80-95%之间上下波动,且无一例患者因麻醉偏浅追加麻醉性镇痛药。二组患者手术结束至喉罩拔除时间无统计学差异（P〉0.05）。二组患者呼吸抑制程度相似（P〉0.05）。结论芬太尼与瑞芬太尼联合无论与异氟醚配伍还是和异丙酚配伍均能维持血流动力学稳定,麻醉恢复快。

Objective： To investigate the advantages and disadvantages of Remifentanil and fentanyl combination analgesia in patients undergoing minor surgeries by observing the anesthesia effect, recovery time and respiratory depression rate. Methods： Forty patients with ASA Ⅰ and Ⅱ mainly undergoing knee arthroscopy were randomly assigned into 2 groups. In remifentanil - fentanyl-based group, fentanyl （1μg. kg^-1） was administered after induction, and followed by remifentanil （lμg. kg^-1） prior skin incision and then remifenatnil （0.2μg. kg^-1. rain^-1 ） infusion, together with isoflurance inhalation or propafol infusion. Results： There were no patients showed behavioral responses in remifentanil - fentanyl based group. The absolute MAP or heart rate deviation from the base - line values in remifentanil - fentanyl - based group were maintained between 80% and 100% of the base - line. The time from the termination of anesthesia to LAM withdraw and full awakeness was similar in two groups （ P 〉 0.05）. There was no significant respiratory depression in two groups which was 65% when combined with isoflurance and 70% when combined with propafol （ P 〉 0.05 ）. There was no awareness identified in all patients. Conclusions： The anesthesia effect is similar in the two groups and the recovery speed is also similar.