瑞芬太尼与芬太尼在全肺大容量灌洗术中的麻醉效果比较

Comparison of anesthesia effect between remifentanil and entanyl in whole lung lavage

目的比较瑞芬太尼与芬太尼复合丙泊酚静脉麻醉在全肺大容量灌洗术麻醉中的有效性、安全性及可控性。方法选择2009年3～5月间ASAⅠ～Ⅱ级的符合全肺灌洗条件的Ⅰ期煤工尘肺患者86例,将其按抽签法随机分为两组,一组患者采用瑞芬太尼复合丙泊酚静脉麻醉,另一组患者采用芬太尼复合丙泊酚静脉麻醉。比较两组患者在麻醉诱导、气管插管期及肺灌洗术中的血压、心率、心电图变化、应激反应及停药后苏醒时间、拔除气管导管时间,比较两组患者的术中用药情况。结果两组患者相比,麻醉诱导及气管插管期,瑞芬太尼组患者发生呛咳、肌肉强直、低血压、心动过缓的几率高于芬太尼组患者,发生高血压、心动过速的几率低于芬太尼组患者,两组患者发生心电图改变的几率无明显差异;全肺灌洗术中,两组患者均能维持平稳的血压、心率,亦无明显的心电图改变,两组患者术中浅麻醉发生率相比无明显差异;停药后,瑞芬太尼组患者的睁眼时间、拔除气管导管时间、出手术室时间明显缩短;术后出现眩晕、烦躁、恶心、呕吐等不良反应的发生率瑞芬太尼组患者低于芬太尼组患者。结论瑞芬太尼与芬太尼复合丙泊酚静脉麻醉均能维持平稳的血流动力学平衡,为全肺大容量灌洗提供较好的麻醉效果;瑞芬太尼具有起效快、维持时间短、苏醒快的特点,与丙泊酚具有更好的协同作用,从而减少了术中丙泊酚的用量。在全肺大容量灌洗术中,瑞芬太尼复合丙泊酚静脉麻醉明显优于芬太尼复合丙泊酚静脉麻醉,瑞芬太尼比芬太尼更安全有效。

Objective To compare the anesthesia efficacy, safety and controllability of remifentanil combined with propofol and fentanyl in the whole lung lavage. Methods 86 patients with coal worker＇s pneumoconiosis stage one were divided into two groups . One group was given remifentanil-propofol anesthesia and another propofol anesthesia.The blood pressure,heart rate,electrocardiogram change,stress reaction,awakening time after drug withdrawal and extubation time were observed, lntraoperative drug use in both groups were compared.Results In the process of anesthesia induction and trachea cannula intubation,the incidence rate of cough, muscle twitch and bradycardia in the remifentanil group were higher than that in the fentanyl group, while the incidence rates of hypertension and tachgcardia were lower than that in the fentanylgroup. There was no significantly difference of the electrocardiogram change between the two groups. After stopped anesthesia, the time of openning eyes, extubation and operative time in the remifentanil group was shorter than that in the fentanylgroup.The incidence rate giddy,restlessness,nausea and vomit in the remifentanil group after operation were slightly lower than those in the fentanyl group.Gonclusion Both anesthesia can provide satisfied effects. Remifentanil combined with propofol has preferable synergistic effect,so the propofol dosage of the remifentanil group were less than that in the fentanyl group. Remifentanil is more safe than fentanyl.