单鼻孔经蝶入路垂体瘤切除术麻醉中瑞芬太尼与芬太尼的临床优缺点

Clinical advantages and disadvantages of remifentanil and fentanyl in anesthesia for single nostril transsphenoidal pituitary tumor resection

目的对单鼻孔经蝶入路垂体瘤切除术麻醉中瑞芬太尼与芬太尼的临床优缺点进行比较。方法 60例拟行单鼻孔经蝶入路垂体瘤切除术患者,按照使用麻醉剂的不同分为瑞芬太尼组(RF组)和芬太尼组(F组),其中RF组32例,F组28例。观察两组患者的中心静脉压(CVP)、心脏指数(CI)、持续心排量(CCO)、收缩压(SBP)、心率(HR)以及听觉诱发电位指数(AEPex)。记录患者在麻醉诱导前、手术插管前、插管后1 min后、凿蝶骨时以及拔管前和拔管5 min后的各项不良反应、麻醉起效的时间和患者的恢复时间,并对其进行分析。结果 F组的麻醉起效及恢复时间大于RF组(P<0.05),RF组在各时间点时,其CVP、CCO、CI、SBP、HR数据的波动差异无统计学意义(P>0.05),F组在各时间点时的相应数据差异有统计学意义(P<0.05),在手术过程中,两组听觉诱发电位指数(AEPex)比较,差异有统计学意义(P<0.05)。结论芬太尼比瑞芬太尼效果作用要弱,对于患者的心肌抑制作用性不强。

Objective To compare the clinical advantages and disadvantages of remifentanil and fentany] in anesthesia for single nostril transsphenoidal pituitary tumor resection. Methods A total of 60 patients undergoing single nostril transsphenoidal pituitary tumor resection were divided by different anesthesia methods into remifentanil （RF） group and fentanyl （F） group, with 32 cases in RF group and 28 cases in F group. Observations were made on central venous pressure （CVP）, cardiac index （CI）, continuous cardiac output （CCO）, systolic blood pressure （SBP）, heart rate （HR） and auditory evoked potential index （AEPex）. Records of adverse reactions, anesthesia effect time, and latients＇ rehabilitation time were made before anesthesia induction, before intubation, and at 1 min after intubation, through sphenoid bone, before extubation ＇and 5 min after extubation： Those records were analyzed. Results The F group had longer anesthesia effect time and rehabilitation time than the RF group （P〈0.05）. The RF group had slight changes of CVP, CCO, CI, SBP, and HR in each time points （P〉0.05）, while the F group had significant changes of these indexes in correspondingtime points （P〈0.05）. The difference of AEPex between the two groups during operation had statistical significance （P〈0.05）. Conclusion Fentanyl has slighter effect than remifentanil on myocardial depression effect in patients.