雷米芬太尼在老年高血压患者腮腺肿瘤手术中的临床应用

Clinical Application of Remifentanil in Aged Patients with Hypertension undergoing Parotid Tumor Surgery

目的:探讨雷米芬太尼在老年高血压患者腮腺肿瘤手术中的临床应用价值。方法:选择拟行腮腺肿瘤手术的高血压患者52例,年龄65～82岁,ASAⅡ或Ⅲ级,随机分成雷米芬太尼组(R)和芬太尼组(F),每组26例。2组均采用全凭静脉麻醉,诱导方法一致。术中R组持续泵入雷米芬太尼0.05～0.2μg/kg.min-1,F组间断给予芬太尼,最大用量不超过8.0g/kg。2组均以丙泊酚和顺式阿曲库铵维持麻醉。记录不同时间点血流动力学参数、术后恢复情况及早期不良反应。结果:R组术中血流动力学更平稳,出血量少,术后苏醒时间和拔管时间较F组显著缩短(P<0.01)。2组患者自主呼吸恢复时间、术后躁动、疼痛和恶心呕吐发生率差异无统计学意义。结论:老年高血压患者行腮腺手术时,采用雷米芬太尼麻醉可维持血流动力学稳定,减少术野出血,提高患者苏醒质量,具有较高的安全性和临床实用性。

[-Abstract] Objective： To explore the clinical application of remifentanil in aged patients with hypertension undergoing parotid tumor surgery. Methods： 52 patients, aged 65-82 years, ASA Ⅱ or Ⅲ, were randomly divided into group R and group F with 26 cases each group. Both groups were given total intravenous anesthesia with consistent induction approach. Patients in group R were continuously infused with remifentanil 0.05-0.2μg/kg · min^-1 whereas those in group F were given fentanyl intermittently with the maximum dose 8.0g/kg during operation. Anesthesia was maintained with propofol and cis-atracurium in the two groups. Hemodynamic parameters, postoperative recovery and early adverse effects were recorded at different time points. Results： The patients in group R had more stable hemodynamics and less volume of blood loss compared with those in group F. Postoperative awake time and extubation time were significantly reduced in R group than those in group F （P〈0.01）. There were no significant differences in recovery time of spontaneous breathing, postoperative restlessness, pain, nauseau and vomitting in two groups. Conclusion： Remifentanil is safe and practicable clinically for aged patients with hypertension undergoing parotid tumor surgery as it can maintain hemodynamics stable, decrease the volume of blood loss and provide a better awakeness.