瑞芬太尼复合丙泊酚全凭静脉麻醉苏醒期躁动的影响

Effects of remifentanil-propofol total itravenous anesthesia on agitation in recovery period patients

目的观察瑞芬太尼复合丙泊酚静脉麻醉不同泵注方法对全麻苏醒期躁动的影响。方法选择ASAⅠ-Ⅱ级择期手术病人60例,随机均分为3组,每组20例,所有病人均以咪唑安定0.03mg/kg,维库溴铵0.1～0.15mg/kg,芬太尼3μg/kg,异丙酚1～2mg/kg诱导。A,B组采用泵注瑞芬太尼复合丙泊酚间断静注维库溴铵麻醉维持,A组在手术结束时同时停用芬太尼和丙泊酚。B组在手术结束前5～10min停用丙泊酚采用单纯瑞芬太尼0.1～0.2ug/kg/min泵注(根据血压、心率调整)C组采用吸入安氟醚间断静注维库溴铵维持麻醉。结果B组病人苏醒期躁动明显少于对照组A,C组(△P<0.05),术后呼吸恢复时间、睁眼时间、拔管时间、答问切题时间比较A组与B组间差异无统计学意义(*P>0.05),C组明显延长(△△P<0.05)。结论瑞芬太尼、丙泊酚全凭静脉复合麻醉采用手术结束前5～10min停用丙泊酚,单纯泵注瑞芬太尼可减少苏醒期躁动。

Objective To compare the emergence and extubation time after two kinds of propofol- remifentanil total intravenous anesthesia or enflurane anesthesia in patients, and the rates of restlessness. Methods Sixty ASA class Ⅰ-Ⅱ patients were randomly divided in to three groups （A;B;C;）with 20 cases each. The patients in study group B received intravenous remifentanil and propofol pumped, and remifentanil was soly infused at the rate. of 0.1-0.2μg/kg/min based on hemodynamic changes from 5-10min before the end of the operation to the extubation time;The patients in control group A received the same but both was stopped when the operation end up. In group C ,the end tidal enflurane concentration （2.5±0.5）% was used instead of remifentanil and propofoi .All the three groups was induced with mindazolam 0.03mg/kg,vecuronium 0.1-0.15mg/kg,propofol 1 -2mg/kg and fentanyl 3μg/kg. Results Patients in group B suffered less incidences of agitation than group A and C（4% vs 50%, 55% ）. Resporation recover time ,open-eye time,extubation time and answer-rightly time in group B were obviously shorter than in group C ,which has no significance compared with group A. Conclusion The remifentanil combined with propofol, using two pump infusion for the total intravenouss anesthesia can decress the rates of restlessness in recovery period when soly infuse remifentanil from 5-10min before the end of the operation to the extubation time.