靶控输注瑞芬太尼或舒芬太尼复合丙泊酚于脊柱手术的对比研究

Comparative Study on Spinal Surgery with Remifentanil or Sufentanil Combined with Propofol

目的:比较靶控输注瑞芬太尼或舒芬太尼复合丙泊酚用于脊柱手术的麻醉效果。方法:选择需要全麻下行脊柱手术的病人40例,随机分为两组:瑞芬太尼复合丙泊酚组(RF组,n=20)和舒芬太尼复合丙泊酚组(SF组,n=20)。全程各药行靶控输注,诱导时各药靶浓度为:瑞芬太尼4.0μg/ml,舒芬太尼0.5μg/ml,丙泊酚3μg/ml;术中维持:丙泊酚浓度不变,瑞芬太尼2～6μg/ml,舒芬太尼0.2～1μg/ml。观察项目包括两组病人的围麻醉期的血流动力学和插管反应的变化。结果:诱导后两组病人的SBP、DBP、HR均明显下降(P<0.05),直至切皮前恢复正常;术后SF组病人呼吸、睁眼、拔管、定向力)恢复情况均比RF组病人明显延迟(P<0.05);RF组OAAS评分仅在术后30分钟高于SF组(P<0.05);术毕30分钟之后各时点RF组VAS评分明显低于SF组(P<0.05或P<0.01);拔管期燥动现象RF组明显多于SF组(P<0.01)。结论:舒芬太尼的麻醉时效长,术后要加强呼吸管理;瑞芬太尼麻醉时效短,术后要及时使用镇痛干预以减少躁动的发生。

Objective： To compare the anesthetic effect in spinal surgery with remifentanil or sufentanil combined with propofol, and to provide the practical basis for the optimum formula of general anesthesia for the surgery. Method：40 cases selected from the patients who would require spinal surgery with general anesthesia were randomly di- vided into two groups ： remifentanil - propo- fol group（ group RF, n = 20） and snfentanil - propofol group （ group SF, n = 40）. The infusion of each drug was target - controlled in the whole course. The target concentration of each drug during induction was that, remifentanil 4. 0ng/ml, sufentanil 0. 5ng/ ml, and propofol 3μg/ml respectively. The concentration of propefol had no change during intraoperative maintenance, with the concentration of remifentanil 2 - 6μg/ml and sufentanil 0.2 - 1 μg/ml respectively. The way to stop injection was that the injection of atracurium, which is a kind of muscle relaxant, was stopped until the end of the operation, while others stopped at the end of skin closure. The observation items contained the perianesthetic hemodynamic changes of the two groups and several items were evaluated during recovery period. Results：SBP, DBP and HR in the two groups initially had no changes （ P 〉 0.05 ）, and then decreased significantly after induction （ P 〈 0. 05 ）, especially in group RF, which returned to normal at the end of skin incision. Every recovery condition in group SF （including breath, eye opening, extubation and orientation） was markedly delayed after operation（ P 〈 0.05 ）. And OAA scores in group RF were higher than that in group SF in 30min after operation （ P 〈 0.05 ）, while there was no statistical difference at other time. Meanwhile, VAS scores in group SF in 30min after operation were better than that in group RF（P 〈 0.05 or P 〈 0.01）. The number of patients with restlessness during extubation in group RF was obviously larger than that in group SF（P 〈0.01）. Conclusions：Anesthesia duration of sufentanil was longer, so the respiratory management should be strengthened after operation. Meanwhile, the anesthesia duration of remifentanil was shorter and analgesia intervention should be made in time after operation to lighten theresdessness.