芬太尼和瑞芬太尼在胸外科手术中的临床效果观察

Anesthesia effect of fentanyl and remifentanil in thoracic surgery

目的比较芬太尼和瑞芬太尼在胸外科手术中的临床安全性和有效性,为胸外科手术选择合理麻醉方式提供参考。方法选择2014年2月—2015年2月接受胸外科手术的142例患者为研究对象,根据麻醉方式不同分为芬太尼组(A组)70例和瑞芬太尼组72例(B组),A组患者麻醉药物为丙泊酚复合芬太尼[25 ng/(kg·min)],B组患者为丙泊酚复合瑞芬太尼[0.2μg/(kg·min)],比较2组患者的术中生理指标、术后苏醒时间,采用Ricker镇静-躁动评分法(SAS)评定患者拔管后15 min的躁动情况,在术后1 h、6 h、12 h采用视觉模拟疼痛评分法(VAS)对患者的疼痛程度进行评分。结果芬太尼组和瑞芬太尼组的平均血压、血氧饱和度和呼吸频率差异均无统计学意义,瑞芬太尼组的平均心率为(60.2±7.8)次/min,苏醒时间为(9.1±1.8)min,分别明显低于芬太尼组的(77.6±5.9)次/min和(15.0±6.1)min,P<0.05,差异具有统计学意义;瑞芬太尼组患者术后拔管15min的镇静-躁动评分为2.1±0.9,芬太尼组为3.4±0.8,P<0.05;瑞芬太尼组患者术后1、6、12 h的疼痛评分均低于芬太尼组患者,差异具有统计学意义(P<0.05)。结论在胸外科手术中,与芬太尼相比,应用瑞芬太尼麻醉的患者术后苏醒时间短,术后镇痛和镇静效果好,瑞芬太尼是一种安全、有效、理想的麻醉药物,值得推广应用。

Objective To compare the clinical safety and efficacy of fentanyl and remifentanil in thoracic surgery, and provide reference for reasonable anesthesia choice in thoracic surgery. Methods Total 142 patients undergoing thoracic surgery in our hospital from February 2014 to February 2015 were chosen for the study and were randomly divided into two groups according to the anesthesia methods, the Fentanyl group with 70 cases （group A） and the Remifentanil group with 72 cases of patients （ group B）. The anesthetics in group A was propofol combined with fentanyl [ 25 ng/（ kg · min） ] , and the anesthetics in group B was propofol and remifentanil [ 0.2 μg/（ kg · min）]. The main physiological indicators during surgery and postoperative recovery time were compared. The restlessness 15 min after the removal of catheter was assessed with Riker sedation-agitation score （ SAS ） , as well as the pain postoperative 1,6,12 h using visual analog pain score （ VAS）, and the pain scores and the sedation-agitation score were compared. Results There was no significant difference in the mean blood pressure, oxygen saturation and respiratory rate between the two groups, and the mean heart rate group B was （ 60.2 ±7.8 ） , and group A was （ 77.6 ±5.9 ） , and the recovery time of the group B was （9.1 ±1.8 ） min, and group A was （ 15.0 ±6.1 ） min,P 〈 0.05, and the difference was statistically significant. The sedation-agitation score of group B was （ 2.1 ±0.9 ）, and group A was （ 3.4 ± 0.8 ）, P 〈 0.05. The pain scores of group B postoperative 1,6,12 h were both lower than that of group A,P 〈 0.05, and the difference was statistically significant. Conclusion In the thoracic surgery, compared with fentanyl, the anesthesia time of remifentanil was shorter than that of the Fentanyl, and remifentanil had better analgesic and sedative effects, and was a safety, efficacy and ideal narcotic analgesic drugs, worthy for clinical application.