瑞芬太尼全麻复合硬膜外麻醉用于开胸手术的临床观察

Clinical observation of remifentanil anaesthesia combined with epidural anesthesia in thoracic surgery

目的观察瑞芬太尼全麻复合硬膜外麻醉在开胸手术中的应用效果和安全性。方法200例择期行开胸手术患者，ASAⅠ-Ⅱ级，按完全随机分组方法分为两组，瑞芬太尼组（R组）与芬太尼组（F组），均采用硬膜外复合气管插管全麻，R组与F组分别采用瑞芬太尼和芬太尼麻醉，观察术前（T0）、气管插管后1min（T1）、5min（T2）、切皮（T3）和术后5min（T4）的血压、心率、血氧饱和度和血中皮质醇水平，记录术后拔管时间及患者的认知能力恢复情况。结果两组气管插管反应发生率相比较，F组（14／26，53．8％）明显高于R组（4／26，15．4％）（P〈0．05）。结论瑞芬太尼较芬太尼能更好地抑制气管插管引起的应激反应，术后患者较早恢复认知能力，且瑞芬太尼静脉全麻复合胸段硬膜外阻滞能提供有效的镇痛和抑制手术刺激引起的血流动力学反应，术后苏醒快，有利于患者术后排痰，康复快。

Objective To investigate the effect and safety of remifentanil anaesthesia combined with epidural anesthesia in thoracic surgery. Methods Two hundred patients, ASA Ⅰ - Ⅱ grade, undergoing thoracotmy were randomly allocated to two groups ： Remifentanil group （group R） and Fentanyl group （group F）. Two groups were given combined general-epidural anesthesia. Patients in group R received remifentanil. Group F received fentanyl. The blood pressure, heart rate, blood oxygen saturation and plasma cortisol were measured before the operation （To）, 1 min （TI） and 5 min （T2） after tracheal intubation, skin incision（T3） and 5 rain after the operation （T4）. The endotracheal extubation time and conscious recovery were recorded. Results Compared with group R, the incidence of endotracheal intubation reaction in group F is significantly higher （group F-14/26,53.8% ;group R-4/26, 15.d%;P〈0.05）. All the patients in group R were extubated and recovered conscious completely at 7 rain after operation. 6 patients in group F were extubated at 25 min after operation and 3 of them recovered recognition completely one hour later. Conclusion Remifentanil have a faster recovery after surgery than fentanyl, and it can effectively inhibit tracheal intubation stress response. Remifentanil anaesthesia combined with epidural anesthesia can provide perfect acesodyne and maintain steady circulation.