瑞芬太尼在心脏瓣膜置换术快通道麻醉中的观察

Remifentanil in cardiac valve replacement in the observation of fast track anesthesia

目的:评价丙泊酚复合瑞芬太尼全凭静脉麻醉对心脏瓣膜置换术患者血流动力学和术后恢复的影响。方法:择期行瓣膜置换术患者24例,随机分为瑞芬太尼组12例(R组)和芬太尼组12例(F组)全凭静脉麻醉,分别在麻醉诱导前(T1)、插管后5 min(T2)、切皮即刻(T3)、锯胸骨即刻(T4)、停机后10 min(T5)、手术结束时(T6)记录BIS、HR、MBP、CVP和术后恢复情况。结果:两组手术一般情况无显著差异,术中BIS及血流动力学指标均较稳定;与F组比较,R组苏醒时间、气管拔管时间和ICU停留时间明显缩短、镇痛药使用率增高。结论:丙泊酚复合瑞芬太尼麻醉适用心脏瓣膜置换术快通道麻醉,术后镇痛需尽早执行。

Objective：To evaluate the changes in hemodynamics and postoperative recovery in patients underwent valve replacement surgery under intravenous anesthesia induced by remifentanil and fentanil.Methods：Twenty-four patients that scheduled for valve replacement with cardiopulmonary bypass were randomly divided into remifentanil group（group R） and fentanil group（group F） with total intravenous anesthesia.Changes in BIS,HR,MBP,CVP were recorded before anesthesia induction（T1）,at 5 min after trachea intubation（T2）,initiation of operation（T3）,initiation of sawing the breastbone（T4）,10 min after discontinuing CPB（T5）,and after sternal closure（T6）.Results：There was no significant difference in patients＇ general status between two groups,BIS and hemodynamic parameters were relatively stable in both groups.Compared with group F,group R showed earlier waking,earlier tracheal decannulation,shorter ICU stay length but more frequently increased pain killer.Conclusion：Propofol combined with remifentanil can be used as fast channel anesthesia in patients that undergo cardiac valve replacement,but postoperative analgesia should be started as early as possible.