瑞芬太尼复合异丙酚全凭静脉麻醉在开腹子宫切除手术中的应用

Application of total intravenous anesthesia of remifentanil combined with propofol in hysterectomy

目的探讨瑞芬太尼复合异丙酚全凭静脉麻醉在开腹子宫切除手术中的麻醉效果及安全性。方法选择美国麻醉医师学会分级I～II,择期行开腹子宫切除手术患者60例,随机分为瑞芬太尼复合异丙酚麻醉组(RF)和芬太尼复合异丙酚麻醉组(F),每组30例。比较两组患者诱导前、拔管时、手术后30min、切皮时、拔管时各时段的平均动脉压(MAP)及心率(HR),术毕停药后监测患者自主呼吸恢复时间、呼唤睁眼时间、拔管时间,并观察患者拔管后的伤口疼痛程度。结果在气管插管时、切皮时、手术后30min和拔管时,RF组的MBP、HR变化幅度均明显小于F组,差异均有统计学意义(t分别=2.89、3.03、2.93、3.12、1.65、1.87、1.54、1.63,P均<0.05);RF组患者术后自主呼吸恢复时间、呼之睁眼时间、拔管时间均明显短于F组,差异均有统计学意义(t分别=3.15、2.89、3.61,P均<0.05)。术后主诉疼痛者明显多于F组,差异有统计学意义(χ2=9.32,P<0.05)。术后24h随访两组患者均无术中知晓。结论瑞芬太尼复合异丙酚全凭静脉麻醉在妇科良性肿瘤手术中麻醉诱导更加平稳,血流动力学更加稳定,苏醒质量高,但因瑞芬太尼消除半衰期短,术后镇痛应及时建立。

Objective To evaluate the anesthetic effects of remifentanil and propofol in hysterectomy. Method A total of 60 ASA physical status Ⅰ and Ⅱ patients undergoing hysterectomy were randomly divided into two groups （n =30）： group RF of remifentanil combined with propofol and group F of fentanil combined with propofol. Hemodynamie variables including MBP and HR before anesthesia induction, during intubation, incision, operation and extubation, as well as the interval from the termination of anesthetics to the full recovery of spontaneous breathing, eye opening at request and tracheal extubation in both of the groups were monitored. Meanwhile, pain status was also recorded. Results Compared to those in group F, the changes of MBP and HR at time point of intubation and incision as well as operation and extubation in group RF were significantly lower （t=2.89, 3.03, 2.93,3.12, 1.65, 1.87, 1.54,1.63, P〈0.05）. The intervals between the termination of anesthetics and the full recovery of spontaneous breathing, eye opening at request and tracheal extubation in group RF were significantly shorted than those in group F （t=3.15, 2.89, 3.61, P〈0.05）. However, the incidence of post-operative pain in group RF was more frequent than that in group F （X^2=9.32, P〈0.05）. Conclusions During gynecologic benign tumor operations, anesthesia by infusion of remifentanil combined with propofol has stable perioperative hemodynamics and quick analepsia, but needs promptly postoperative analgesia for the short half-life of remifentanil.