瑞芬太尼复合丙泊酚把空输注在非体外循环冠脉搭桥手术中的应用

Target controlld infusion of propofol with remifentanil for of-pump cardiac artery by pass graft

目的探讨丙泊酚复合瑞芬太尼靶控输注在非体外循环冠脉搭桥手术中应用的临床意义。方法选择32例择期行非体外循环冠脉搭桥手术病人。采用瑞芬太尼复合丙泊酚靶控输注,瑞芬太尼丙泊酚靶控浓度分别为1.6ng/ml和1.5-4μg/ml辅以安氟醚吸入,间断推注维库溴铵。记录围麻醉期血流动力学,及麻醉后恢复情况。结果所有病人麻醉诱导后收缩压舒张压均明显降低（P〈0.05）,心率减慢（P〈0.05）气管插管、切皮后血压回升。术毕停用瑞芬太尼后心率加快、血压升高,需辅以长效镇痛药物。术毕病人均在5h内拔气管插管。结论瑞芬太尼复合丙泊酚靶控输注用于非体外循环冠脉搭桥手术,血流动力学稳定,对气管插管和锯胸骨等强刺激反应轻微;术后清理迅速,可安全用于非体外循环冠脉搭桥手术的麻醉。

Objective To explore the clinical effects of propofol with remifentanil target controlled infusion for OPCABG. Methods Thirty- two patients with cardiac artery disease were randomly anesthetized with target controlled infusion of propofol（ 1.5 -4μg/ml）and remifentanil（ 1.6 ng/ml）. Enfulrane was used as aid to the treatment and vecuronium bromide was injected at intervals. The hemodynamic changes and recovery of anesthesia were observed in all patient. Results Blood pressure was significantly lower and HR decreased after induction of anesthesia （ P 〈 0.05 ） , and remained stable after intubation and skin incision. All patients felt comfortable in the recovery of anesthesia ,and extubation was done in 6 hours after operation. Conclusions Target controlled infusion of propofol with remifentanil for introvenous and inhalation anesthesia,has advantages of rapid induction of anesthesia, stability of hemodynamics and no complications of anesthesia. It is very suitable for OPCABG.