两种不同输注方法对胸科手术麻醉的临床效果比较

Comparison of clinical effects of two different infusion methods of anesthesia for thoracic surgery

目的比较静脉注射和靶控输注瑞芬太尼复合异丙酚两种输注方法在胸科手术麻醉中的临床效果。方法 40例胸科全麻手术患者随机分为两组:静脉注射瑞芬太尼复合异丙酚组(IR组)和靶控输注瑞芬太尼复合异丙酚组(TR组)。IR组麻醉前30 min给予咪唑安定0.05 mg/kg和阿托品0.5 mg,静脉注射异丙酚2.5 mg/kg复合瑞芬太尼4μg/kg;TR组静脉注射异丙酚2.5 mg/kg复合靶控输注瑞芬太尼6 ng/ml,其余用药同IR组。术中监测血压、心率、血氧饱和度和脑电双频指数,并比较两组患者自主呼吸时间、睁眼时间、拔管时间、OAAS评分达5级时间、术中知晓和术后不良反应。结果 TR组术中循环相对平稳,自主呼吸时间、睁眼时间、拔管时间、OAAS评分达5级时间明显小于IR组(P<0.05),两组术后恶心呕吐不良反应发生率差异无统计学意义。结论瑞芬太尼复合异丙酚靶控输注较静脉注射更能提供稳定的血流动力学并维持有效的麻醉深度,更适合胸科手术患者的麻醉。

Objective To compare the anesthesia effects of intravenous injection versus target controlled infusion（TCI） of remifentanil combined with propofol in patients under going thoracic surgery. Methods Forty patients undergoing thoracic surgery were enrolled in this study, and randomly divided into two groups： intravenous remifentanil combined with propofol group（ IR group, n = 20） ,and TCI of remifentanil combined with propofol group （TR group, n = 20）. In IR group, the patients were intramuscularly administrated with mi- dazolam 0.05 mg/kg and atropine 0.5 mg/kg before anesthesia, and propofol 2.5 mg/kg and remifentanil 4 μg/kg were injected intra- venously at the beginning of induction. In TR group, anesthesia was induced with propofol 2.5 mg/kg and TCI of remifentanil 6 ng/ ml, but the doses of the other drugs were the same as those in IR group. Mean arterial blood pressure （MAP）, heart rate（ HR）, surplus pulse 02 （SpO2）and the bispectral index （BIS） were recorded and compared. Time of spontaneous breathing, eye opening, extuba- tion, OAAS scored 5, intraoperative awareness and postoperative adverse reactions were compared between two groups. Results The circulation in TR group was relatively stable during the operation. Time of spontaneous breathing, eye opening, extubation and OAAS scored 5 in IR group was significantly longer than in TR group（ P 〈 O. 05 ）. There was no significant difference in postoperative nausea and vomiting between two groups. Conclusion TCI of remifentanil combined with propofol can supply hemodynamic stability and maintain an effective depth of anesthesia.