瑞芬太尼丙泊酚复合麻醉在鼻内窥镜下行三叉神经上颌支部分切除术的应用

The application of remifentanil propofol combined anesthesia in trigeminal nerves ramus maxillaris partial resection by nasal organ endoscope

目的探讨瑞芬太尼丙泊酚复合麻醉用于内窥镜下三叉神经上颌支部分切除术的麻醉效果及安全性。方法选择长期三叉神经上颌支痛行内窥镜下三叉神经上颌支部分切除术的患者40例,分为R组(瑞芬太尼复合丙泊酚组)和F组(芬太尼复合丙泊酚组),每组20例。麻醉诱导R组采用静脉注射丙泊酚1.5mg/kg、瑞芬太尼2μg/kg、维库溴铵0.1mg/kg和咪唑安定0.1mg/kg;F组将瑞芬太尼改为芬太尼2μg/kg,余同R组,微泵注丙泊酚、瑞芬太尼(R组)或芬太尼(F组)并吸入异氟醚及间断静注维库溴铵维持麻醉。观察麻醉前、诱导、气管插管时,术中及术毕的血流动力学变化,同时观察麻醉苏醒及不良反应等情况,术中根据需要行控制性降压。结果在气管插管和麻醉维持期间,瑞芬太尼组血流动力学变化幅度显著小于芬太尼组(P<0.05)。两组患者手术结束至呼之睁眼的时间瑞芬太尼组明显短于芬太尼组(P<0.01)。瑞芬太尼组需要行控制性降压例数或使用降压药明显少于芬太尼组,不良反应两组间差异无显著性。结论瑞芬太尼丙泊酚复合麻醉可安全用于内窥镜下三叉神经上颌支部分切除术,患者术中血流动力学更为稳定,停止输注后作用消退快于芬太尼,术后苏醒、拔管时间缩短,不良反应少,尤其适用于老年病人的麻醉。

Objective To approach anaesthesia effect and safety of remifentanil propofol combined anesthesia in trigeminal nerves ramus maxillaris partial resection by nasal organ endoscope. Methods We choose 40 case patients who will be taken trigeminal nerves ramus maxillaris partial resection because of long-term ache of trigeminal nerves ramus maxillaries, divide them into R group （remifentanil and propofol） and F group （fentanyl and propofol）, every group has 20 cases. We apply intravenous injection propofol 1.5mg/kg, remifentanil 2μg/kg, vecuronium bromide 0.1mg/kg and Midazolam 0. lmg/kg to take anesthesia induction in R group, only change remifentanil to fentanyl 2μg/kg in F group. We apply minipump to inject propofolum, remifentanil or fentanyl, to breathe in isoflurane and disjunction intravenous injection vecuronium bromide at the same time to maintain anesth. We observe the variation of haemodynamics before anesth, derivation, tracheal intubation, operation, after operation, to observe anesth analepsia adverse effect at the same time, to control hypotension according to demand in operation. Results The amplitude of haemodynamics variation in remifentanil group is very little than that in fentanyl group during the time of tracheal intubation and maintenance of anesthesia （P〈0.05）. The time from operation completed to open the eyes by calling in remifentanil group is very short than that in fentanyl group. The cases need to be controlled hypotension or to be used hypotensive drug in remifentanil group is very little than that in fentanyl group, adverse effect difference in two groups has no significance. Conclusions Remifentanil propofol combined anesthesia can be applied safely in trigeminal nerves ramus maxillaris partial resection by nasal organ endoscope. The variation of haemodynamics is more stable, the effect subside more fast than fentanyl, the time of analepsia and extubate is decurtation,it has few adverse effect. The anaesthesia method refer to elderly patient especially.