瑞芬太尼靶控输注的优越性及临床应用

The advantage and clinical application of remifentanil administered by target-controlled infusion

背景瑞芬太尼是一种新型阿片类麻醉药，其起效迅速，时量半衰期短，长时间输注无蓄积，适合靶控输注（target-controlled infusion，TCI）给药。目的评价瑞芬太尼TCI系统的优点和不足，使该系统得以优化。内容瑞芬太尼TCI系统可控性好，能提供稳定的血流动力学，并能降低其他麻醉药的用量，可应用于全身麻醉的诱导和维持、清醒插管、无痛人工流产（人流）、区域阻滞等麻醉过程中。该系统存在一定的不足，如适合中国人的药代动力学模型还不完善，血药浓度检测技术不能满足要求，监测指标较为局限等，这些问题均需要进一步的研究。趋向改进目前的瑞芬太尼TCI系统将会使其获得更广泛的临床应用范围。

Background Remifentanil is a novel, short-acting μ-opioid receptor agonist. Its context-sensitive half-time is very short, and there is no accumulation of effects after remifentanil withdrawal, regardless of time of administration. The pharmacokinetic characteristics make remifentanil suitable for administration by target-controlled infusion （TCI）. Objective To evaluate the advantage and disadvantage of remifentanil administered by TCI in order to facilitate its improvement. Content Remifentanil administered by TCI is easy to be controlled and can provide a steady haemodynamies. Dosage of other anesthetics can be reduced when used along with remifentanil TCI. Remifentanil administered by TCI can apply to various types of anesthesia, such as induction and maintenance of general anesthesia, awake intubation, painless abortion and local block. Disadvantages existed in this TCI include imperfection of pharmacokinetics model for Chinese, limited ability of technique for measuring blood concentration of remifentanil, and lack of effective monitoring indicators for pain, which rleed to be researched further. Trend Improvement of the current remifentanil TCI will make it gain a wider application in clinical anesthesia.