瑞芬太尼与芬太尼在靶控输注全麻中的比较

Comparison of Target-controlled Infusion of Remifentanil and Fentanyl on Anesthesia

目的:比较瑞芬太尼与芬太尼在靶控输注(TCI)全麻中的麻醉效果。方法:选择2010年11月-2012年11月期间择期行全麻开腹手术的非孕女性患者60例,随机分为瑞芬太尼组和芬太尼组,每组30例,瑞芬太尼组采用瑞芬太尼2μg/kg TCI泵入,芬太尼组采用芬太尼2.5μg/kg TCI泵入。比较两组患者围术期收缩压(SBP)、舒张压(DBP)、心率(HR)的变化和麻醉诱导后呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间。结果:两组诱导前SBP、DBP、HR值及诱导后DBP值之间差异均无统计学意义(P>0.05)。瑞芬太尼组诱导后、插管后、手术开始时的SBP较芬太尼组均显著降低,其差异有统计学意义(P<0.05)。瑞芬太尼组插管后、手术开始时的HR较芬太尼组均显著降低,其差异有统计学意义(P<0.05)。瑞芬太尼组的呼吸恢复时间、睁眼时间、拔管时间及定向力恢复时间均较芬太尼组延长,其差异有统计学意义(P<0.05)。结论:瑞芬太尼具有安全、高效、苏醒迅速、不蓄积等特点,比芬太尼更有效地降低血压和心率,抑制气管插管和手术应激的高血压反应,故有良好的临床应用价值。

Objective： To compare anesthetic effect of remifentanil and fentanyl anesthesia by target-controlled infusion （ TCI ） . Method： 60 nonpregnant women patients with selective operation laparotomy were selected and were randomly divided into remifentanil （ n=30 ） and fentanyl groups （ n=30 ） . Remifentanil group, use 2 p~ g/kg remifentanil pump into by TCI and fentanyl group use 2.5 p~ g/kg fentanyl pump into by TCI. Perioperative systolic blood pressure （ SBP ）, diastolic blood pressure （ DBP ）, heart rate （ HR ）, breathing recovery time, time to eye opening, time to extubation, orientation recovery time after induction of anesthesia were compared between two groups. Result： There were no significant differences that SBP, DBP, HR values before induction of anaesthesia and induced DBP value between the two groups （ P〉0.05 ） . SBP after induction, intubation, surgery starting in remifentanil group were significantly lower than those in fentanyl group and the difference was statistically significant （ P〈O.05 ） . HR after intubation and surgical beginning in Remifentanil group were significantly lower than those in fentanyl group and the difference were statistically significant （ P〈0.05 ） . Breathing recovery time, time to eye opening, time to extubatian and orientation recovery time in remifentanil group were significantly extend than those in fentanyl group and the difference were statistically significant （ P〈0.05 ） .Conclusion： Remifentanil is a good clinical value that is safety, efficiency, wake up quickly, not accumulate, lower blood pressure and heart rate more effectively, lower hypertension reaction of endotracheal intubafion and surgical stress than fentanyl.