单独使用瑞芬太尼用于经皮肝癌射频消融手术的麻醉

Remifentanil as a Single Agent to Provide Analgosedation for Percutaneous Radiofrequency Ablation of Hepatic Cancer.

目的 探讨单独使用瑞芬太尼为经皮肝癌射频消融手术提供镇静镇痛麻醉的可行性和安全性.方法 选取30例ASA Ⅰ～Ⅲ级拟行经皮肝癌射频消融术的患者.所有患者均未给予术前用药.手术开始前,首先给予瑞芬太尼0.1μg/（kg·min）持续输注,然后以0.01μg/（kg· min）的增减量调整输注速率,直到患者的镇静评分（OAA/S评分法）达到3分左右时开始手术.术中监测患者的血压、心率、血氧饱和度、呼吸频率.同时观察患者的体动、呼吸抑制等任何不良反应.术后随访患者的满意程度和术中知晓情况.结果 所有患者均顺利完成手术.术中血流动力学稳定,无明显不良反应发生.瑞芬太尼的平均输注速率为0.15 ±0.01μg/（kg·min）,使用总量为6.63±1.51μg/kg.手术结束停药后,患者的意识恢复时间为11±2min.尽管部分患者呼吸频率出现明显降低,但血氧饱和度均维持在90％以上.结论 单独使用瑞芬太尼可以安全有效的用于经皮肝癌射频消融术的镇静麻醉,其产生的轻度呼吸抑制作用并无临床意义,但部分患者对手术过程的记忆仍需值得注意.

Objective To investigate the feasibility and safety of remifentanil as a single agent providing analgosedation for percutaneous radiofrequency ablation of hepatic caner.Methods Thirty patients,ASA Ⅰ-Ⅲ,scheduled for percutaneous radiofrequency ablation of hepatic caner were enrolled in the study.No patients received premedication.All patients received continuous infusion of remifentanil at an initial dose of 0.1μg/（kg · min）,which was titrated by an increment or decrement of 0.01 μg/（kg · min） to achieve OAA/S score of 3 （2-4）.Blood pressure,heart rate,blood oxygen saturation and respiratory frequency were monitored.Also,the adverse events such as dyspnea,body movement were noted.Results The procedure was successfully finished in all patients without any severe adverse events.To obtain the adequate sedation state,the average infusing rate of remifentanil was 0.15 ± 0.01 μg/（kg · min）.The total consumption of remifentanil was 6.63 ± 1.51μg/kg.The recovery time from sedation state to fully awake was 11 ± 2min.The blood oxygen saturation was maintained above 90%,although a significant decrease in respiratory frequency occurred in some cases.Conclusion Analgosedation with remifentanil as a single agent is a feasible and safe technique for percutaneous radiofrequency ablation of hepatic caner without any severe adverse effects.The associated slight respiratory depression is clinically insignificant.The recall of intraoperative events might be a relative concern.