瑞芬太尼复合异丙酚在鼻内窥镜术中的应用

Management of Remifentanil Combined with Propofol for Nasal Endoscopy

目的探讨比较瑞芬太尼复合异丙酚,芬太尼复合异丙酚用于鼻内窥镜术麻醉的安全性和有效性。方法60例行鼻内窥镜术患者随机分为两组,每组30例,瑞芬太尼复合异丙酚组(Ⅰ组)和芬太尼复合异丙酚组(Ⅱ组)。麻醉诱导用咪唑安定0.05～0.1mg/kg、异丙酚2mg/kg、瑞芬太尼2μg/kg或芬太尼4～6μg/kg、万可松0.1mg/kg、静脉诱导气管插管、术中用异丙酚4～6mg(/kg.h)、瑞芬太尼0.2μg(/kg.min)或芬太尼2μg(/kg.h)万可松0.6～0.8μg(/kg.min)维持麻醉。两组均待手术结束鼻腔填塞碘仿纱条后停止泵入麻醉药。观察比较两组麻醉诱导及术中心率、收缩压、舒张压、脉搏血氧饱和度、麻醉苏醒及不良反应等情况。结果两组患者麻醉诱导后收缩压、舒张压、心率较基础值均明显降低(P<0.05),麻醉维持过程中Ⅰ组收缩压、心率较Ⅱ组收缩压、心率低(P<0.05),两组间脉搏血氧饱和度(SPO2)比较无显著性差异(P>0.05),Ⅰ组呼吸恢复时间、清醒时间、拔管时间短于Ⅱ组(P<0.05)。结论瑞芬太尼复合异丙酚能有效抑制气管插管过程中的心血管反应,麻醉维持期间患者血流动力学变化幅度小,术中血压维持在适宜水平,减少了术中出血,且术后苏醒、拔管快。

Objective To compare the safety and effectiveness of remifentanil combined propofol and fentanyl combined with propofol for nasal endoscopy anesthesia safety and effectiveness. Methods 60 patients undergoing for nasal endoscopy were randomly divided into two groups （n=30）, remifentanil combined propofol group （group Ⅰ ） and fentanyl combined propofol group （group Ⅱ）. Anesthesia was induced with midazolam 0.05-0. 1mg/kg, propofol 2mg/kg, remifentanil 2 μ g/kg or fentanyl 4- 6 μg/kg, vecuronium 0. 1mg/kg, intravenous induction and intubation, and was maintained with a continuous infusion of Propofol 4-6mg/（kg·h）, Remifentanil 0.2μg/（kg·min） or Fentanyl 2μg/ （kg·h）, Veeuronium 0.6-0.8μg/ （kg·min）. Both groups were to be the end of nasal surgery after the cessation of gauze packing iodoform pumped into anesthetics. Comparison of the two groups of induction of anesthesia and intraoperative of heart rate（HR）, systolic blood pressure （SBP） and diastolic blood pressure （DBP）, the pulse oxygen saturation （SPO2）, recovery from anesthesia and adverse reaction, and so on. Results Two groups induction process of systolic blood pressure（SBP） and diastolic blood pressure（DBP）, heart rate（HR） than induced the basic value decreased significantly（P〈0.05）, the process of anesthesia group Ⅰ systolic blood pressure（SBP） and heart rate（HR） compared to group Ⅱ shrink pressure （SBP） and heart rate （HR）（P〈0.05）, between the two groups pulse oxygen saturation（SPO2） comparative no significant difference （P〉 0.05）. Group Ⅰ respiratory recovery time, sober, extubation time was shorter than group Ⅱ （P〈 0.05）. Conclusion Remife- ntanil combined with propofol are effective inhibitors of endotracheal intubation in the process of cardiovascular response during anesthesia maintenance hemodynamics in patients with small rate changes, for the maintenance of blood pressure reduction in the level appropriate bleeding, postoperative recovery, rapid extubation.