单用瑞芬太尼与芬太尼、瑞芬太尼复合应用对全麻苏醒拔管期心血管反应的影响

Comparison of the cardiovascular response at extubation period of general anesthetic postoperation using remifentanil only and remifentanil combined with fentanyl

目的比较单用瑞芬太尼与芬太尼、瑞芬太尼复合应用对全麻苏醒拔管期心血管反应的影响。方法全麻行腹腔镜下胆囊切除术患者40例,ASA分级I-II级,随机分为两组:瑞芬太尼组(R组)和芬太尼+瑞芬太尼组(FR组),每组各20例。两组分别以瑞芬太尼1μg/kg和芬太尼5μg/kg复合咪达唑仑0.05mg/kg,维库溴铵0.1mg/kg,异丙酚1.5mg/kg诱导。两组均以瑞芬太尼0.2μg·kg-1·min-1复合异丙酚(5-6)mg·kg-1·h-1泵注维持麻醉,间断静注维库溴铵,手术结束时停用异丙酚和瑞芬太尼。观察麻醉前、拔管时、拔管后1min、拔管后5min、拔管后10min的平均动脉压和心率;观察患者呼吸恢复时间、睁眼时间、拔管时间。结果R组拔管时、拔管后1min、5min的平均动脉压和心率较FR组明显升高(P<0.05);两组呼吸恢复时间、睁眼时间、拔管时间差异无统计学意义。结论芬太尼瑞芬太尼复合应用较单用瑞芬太尼能更有效抑制全麻苏醒拔管期的心血管反应,且不延长苏醒时间。

Objective To compare the cardiovascular response at extubation period of general anesthetic postoperation using remifentanil only and remifentanil combined with fentanyl. Methods Forty ASA class Ⅰor Ⅱpatients of laparoscopic cholecystectomy were randomly and equally divided into remifentanil group （R） and fentanyl -remifentanil group（FR）. Remifentanil 1 μg/kg in group R and fentanyl 5μg/kg in group FR combined with midazolam 0. 05 mg/kg, vecumnium 0.1 mg/kg and propofol 1.5 mg/kg were used for anesthesia induction. 0. 2μg · kg^-1 · h^-1 dose of remifentanil and 5 -6mg · kg^-1 · h^-1 dose of propofol were infused to maintain anesthesia. MAP, HR and the revival time were observed. Results MAP and HR in group R significantly rised compared with group FR at the time of extubation, 1 minute and 5 minutes after extubation （P 〈 0.05）. The time of breathing recovery, eye opening, extubation had no significant difference in two groups. Conclusion Fentanyl combined with remifentanil can depress the cardiovascular response at extubation period of general anesthetic postoperation more effectively than remifentanil only, meanwhile, does not prolong revival time.