舒芬太尼与瑞芬太尼在小儿脊柱侧弯手术唤醒中的联合应用

Application of sufentanil combined with remifentanil on wake-up test in anesthesia for scoliosis surgery

目的比较舒芬太尼联合瑞芬太尼与芬太尼联合瑞芬太尼用于脊柱侧弯矫形手术麻醉对术中唤醒试验的影响。方法选择ASAⅠ～Ⅱ级脊柱侧凸后路矫形手术患者40例,随机分为2组,每组20例。Ⅰ组用舒芬太尼1μg/kg诱导。Ⅱ组用芬太尼5μg/kg诱导,2组术中吸入七氟醚及笑气,持续静脉泵入瑞芬太尼维持麻醉。记录唤醒时间,呼气末七氟醚浓度(ETsev),唤醒期间血流动力学变化以及唤醒期躁动呛咳例数等。结果两组唤醒期间血液动力学变化无显著性差异。Ⅰ组患者唤醒时间为(8.5±1.2)min短于Ⅱ组的(12.3±2.4)min,P﹤0.05;唤醒期间呛咳躁动发生率I组为10%,明显低于Ⅱ组的40%(P﹤0.05)。结论舒芬太尼联合瑞芬太尼应用于脊柱侧弯手术唤醒试验中能够缩短唤醒时间,唤醒质量高,更适用于脊柱手术。

Objective To compare the effects of sufentanil and remifentanil combination with fentanyl and remifentanil on the wake-up test in scoliosis surgery.Methods Forty ASAⅠ～Ⅱpatients undergoing scoliosis surgery were randomly divided into sufentail and remifentail combination group（groupⅠ,n=20） and fentanyl and remifentanil combination group（groupⅡ,n=20）,sufentanil 1μg/kg was used in groupⅠwhile fentanyl 5μg/kg was used in groupⅡ.The anesthesia was maintained with inhaling sevoflurane and nitrous oxide and continuous intravenous infusion of remifentanil in both groups.The wake-up test time,end-tidal sevoflurane concentration,bucking and restlessness and hemodynamic variables including MAP and HR during the wake-up test were recorded.Results The circulatory functions were stable during the wake-up test time in both groups.The wake-up test time in groupⅠwas significantly earlier than that in groupⅡ.Compared with groupⅡ,fewer bucking and restlessness happened during the wake-up test in groupⅠ.Conclusion Sufentanil and remifentanil combination can shorten the intra-operative wake-up test time,and have a good quality of wake-up test.So it is an appropriate anesthetic technique for scoliosis surgery.