瑞芬太尼与丙泊酚混合后用于静脉麻醉的临床观察

Clinical observation of TCI anesthesia using propofol and remifentanil mixture

目的:探讨瑞芬太尼与丙泊酚混合后应用于靶控输注(TCI)静脉麻醉的可行性及安全性。方法:选择ASAⅠ～Ⅱ级,择期胃癌根治性手术患者400例。按给药方式不同,随机分为4组:单泵混合药物I组和Ⅱ组、双泵并用药物Ⅲ组和Ⅳ组。术中维持BIS在45～55之间。用同一标准观察4组血流动力学变化、副作用及麻醉稳定性。结果:单泵混用组与双泵并用组诱导期、麻醉维持期各时间点各观察指标无明显差异。4组麻醉效果无显著性差异(P>0.05)。副作用发生率无显著性差异(P>0.05);自主呼吸恢复时间和苏醒时间相似,Ⅰ和Ⅲ、Ⅱ和Ⅳ无差异(P>0.05);Ⅰ、Ⅲ组较Ⅱ、Ⅳ组时间短,统计学有差异(P<0.05)。结论:瑞芬太尼与丙泊酚混合后应用于术中血流动力学稳定,术后苏醒快,拔管早,不降低疗效,不增加副作用,操作方便,可安全用于TCI。

Objective： To investigate the feasibility and security of TCI with propofol-remifentanil mixture.Methods： A total of 400 ASA ⅠorⅡpatients undergoing selected gastroectomy were divided into randomly four groups：single TCI groups（groupⅠandⅡ） and double TCI groups（group Ⅲ and Ⅳ）.The patients＇ MAP and HR were recorded at different time points including baseline values,post-anesthesia induction,tracheal intubation,3 min after tracheal intubation,skin incision and surgical exploration.After the surgery,recovery time of spontaneous respiration,recovery of consciousness and the incidence of adverse events were documented.The concentration of propofol was adjusted by BIS ranging between 40 and 50.Results： There were no significant difference in haemodynamics and side effects at different time points among the four groups.Although there were no significant difference in recovery time of spontaneous respiration and the consciousness time in group Ⅰand Ⅲ or Ⅱand Ⅳ,there were significant difference in group Ⅰ/Ⅲ and Ⅱ/Ⅳ.Conclusion： Compared to double TCI with propofol-remifentanil,TCI with propofol-remifentanil admixtures is safe and stable,the anesthetic depth can be easily adjusted.