瑞芬太尼、丙泊酚复合氟比洛芬酯在心脏手术快通道麻醉中的应用

Application of Remifentanil, Propofol Combined with Flurbiprofen Axetil in Fast Track Anaesthesia of Cardiac Surgery

目的研究瑞芬太尼、丙泊酚复合氟比洛芬酯在心脏手术快通道麻醉中的应用效果。方法将86例拟行冠状动脉旁路移植术患者随机分为两组各43例。对照组采用瑞芬太尼、丙泊酚麻醉,观察组在此基础上复合氟比洛芬酯麻醉。观察两组麻醉前(T0)、插管前(T1)、插管后(T2)、开胸后(T3)、手术结束时(T4)血流动力学情况、疼痛情况及不良反应情况。结果两组患者T0、T1、T2、T3时HR、MAP比较均无显著差异(P>0.05);观察组T4时MAP与对照组比较无显著差异(P>0.05),但HR明显低于对照组(P<0.05)。观察组患者术后2 h、4 h、8 h、12 h、24 h VAS评分均明显低于对照组(P<0.05)。观察组和对照组不良反应发生率分别为4.65%、18.60%,观察组明显较低(P<0.05)。结论冠状动脉旁路移植术患者采用瑞芬太尼、丙泊酚复合氟比洛芬酯建立快通道麻醉效果显著,对血流动力学影响较小,术后疼痛较轻,不良反应少,值得临床应用及推广。

Objective To study the application effect of remifentanil, propofol combined with flurbiprofen axetil in fast track anaesthesia of cardiac surgery. Methods 86 patients undergoing CABG were randomly divided into two groups, with 43 cases in each group. The control group was given remifentanil and propofol for anesthesia, the observation group was given flurbiprofen axetil on this basis. The conditions of hemodynamics before anesthesia （To）, before intubation （TI）, after intubation （T2）, after thoracotomy （T3） and at the end of the operation （T4）, pain and adverse reactions were observed. Results The HR and MAP of two groups at To, T1, T2, T3 had no significant difference （P〉0.05）; the MAP of observation group at T4 had no statistical difference compared with control group （P〉0.05）, but the HR was lower than that of control group （P〈0.05）. The VAS scores of observation group 2 h, 4 h, 8 h, 12 h, 24 h after operation were lower than those of control group （P 〈0.05）. The adverse reactions rate of observation group was 4.65%, lower than 18.60% of control group （P〈0.05）. Conclusions Remifentanil, propofol combined with flurbiprofen axetil in fast track anaesthesia of CABG has significant effect, and has less influence on hemodynamics, less postoperative pain and fewer adverse reactions, which is worthy of clinical promotion.