舒芬太尼和瑞芬太尼复合丙泊酚静脉麻醉用于神经外科手术的对比

Propofol-sufentanil versus Propofol-remifentanil as Total Intravenous Anesthesia for Neurosurgery

目的比较舒芬太尼、瑞芬太尼复合丙泊酚全凭静脉麻醉在神经外科非急诊手术中的麻醉效果和术后镇痛效果。方法 80例美国麻醉医师协会Ⅰ~Ⅱ级神经外科择期手术患者,随机分为舒芬太尼（S）组和瑞芬太尼（R）组各40例。麻醉诱导采用咪达唑仑0.05 mg.kg-1、维库溴铵0.1 mg.kg-1、丙泊酚1.5 mg.kg-1。S组舒芬太尼0.25μg.kg-1,R组瑞芬太尼1μg.kg-1。气管插管后机械通气,两组均以持续静脉泵注丙泊酚6~10 mg.kg-1.h-1维持,间断追加维库溴铵。同时,S组持续静脉泵注舒芬太尼0.002 5μg.kg-1.min-1,R组持续静脉泵注瑞芬太尼0.1~0.2μg.kg-1.min-1。记录两组患者术前及麻醉期间的血压、心率,观察手术结束后患者麻醉苏醒时间、拔管时间、不良反应、视觉模拟评分（VAS）及术后镇痛药用量等。结果 R组麻醉苏醒时间、拔管时间分别为（6.4±2.5）和（11.6±5.3）min,均明显短于S组[分别为（12.6±6.4）和（16.2±7.4）min]（均P〈0.05）。拔管后6 h内两组不良反应差异无统计学意义。S组术毕60,90,120 min VAS评分优于R组（均P〈0.05）。R组术后曲马多用量为（557.6±54.3）mg,明显大于S组[（312.4±47.7）mg]（P〈0.05）。结论舒芬太尼-丙泊酚与瑞芬太尼-丙泊酚全凭静脉麻醉都能有效地应用于神经外科手术,使用瑞芬太尼后麻醉苏醒较快,而使用舒芬太尼术后镇痛效果较好。

Objective To compare the efficacy and postoperative analgesia of either sufentanil or remifentanil combined with propofol as total intravenous anesthesia in patients undergoing nonemergency neurosurgery. Methods 80 patients of ASA Class Ⅰ～Ⅱ who were scheduled for a neurosurgery were randomized into two groups： sufentanil（S） group and remifentanil（R） group.Anesthesia was induced with propofol and either sufentanil 0.25 μg·kg-1 or remifentanil 1 μg·kg-1.Infusion rate of propofol were 6-10 mg·kg-1·h-1 in both groups.Maintenance infusion rates for sufentanil and remifentanil were 0.002 5 μg·kg-1·min-1 and 0.1-0.2 μg·kg-1·min-1,respectively.Patients＇ hemodynamic condition was monitored throughout the anesthesia procedure.And the awakening time,extubation time,postoperative complications,visual analogue scale（VAS）and tramadol consumption were recorded. Results The awakening and extubation time in R group were significantly shorter than those in S group（6.4±2.5）,（11.6±5.3）min vs（12.6±6.4）,（16.2±7.4）min（P0.05）.Side effects in both groups showed no significant difference within 6 h after extubation.Tramadol consumption for postoperative pain relief in R group was greater than in S group [（557.6±54.3） mg] vs [（312.4±47.7） mg]（P0.05）.VAS of 60,90,120 min postoperation in S group were lower than those in R group（P0.05）. Conclusion Total intravenous anesthesia by using either sufentanil or remifentanil in combination with propofol can be effectively applied in neurosurgery,with a faster awakening time by remifentanil and a satisfactory postoperative analgesia effect by sufentanil.