瑞芬太尼复合异丙酚靶控输注对脊柱结核手术患者麻醉效果及安全性评价

The evaluation of anesthetic efficacy and safety of target-controlled infusion of remifentanil combined with propofol on spinal tuberculosis surgery

目的探讨瑞芬太尼复合异丙酚靶控输注对脊柱结核手术患者麻醉效果及安全性评价。方法选取2014年1月—2015年12月在内蒙古医科大学附属医院接受治疗的脊柱结核患者80例,采用随机的方法将患者分为观察组和对照组,每组各40例患者。观察组患者采用瑞芬太尼联合异丙酚靶控静脉麻醉,对照组患者采用异丙酚联合瑞芬太尼麻醉,比较两组患者自主呼吸恢复时间、睁眼时间、睫毛反射时间、指令动作恢复时间、拔管时间以及离开恢复室时间等,观察2组患者治疗前后心率和呼吸频率改善情况,并且对两组麻醉方式不良反应进行比较。结果 (1)麻醉后,观察组患者的自主呼吸恢复时间、睁眼时间、睫毛反射时间、指令动作恢复时间、拔管时间以及离开恢复室时间[(3.12±0.35)、(6.45±1.20)、(5.12±0.45)、(9.12±2.31)、(13.56±3.12)、(17.46±3.12)min]短于对照组[(4.56±0.41)、(8.12±2.11)、(6.89±0.18)、(10.39±0.41)、(18.45±4.01)、(19.45±4.30)min],两组差异有统计学意义(P<0.05);(2)麻醉后,两组患者的心率以及呼吸频率均有所下降,观察组[(50.31±8.12)、(18.02±3.01)次/min]下降幅度与对照组[(45.23±9.78)、(12.45±3.49)次/min]相比差异具有统计学意义(P<0.05),瑞芬太尼复合异丙酚麻醉对于患者心率及呼吸影响明显优于异丙酚联合芬太尼麻醉;(3)观察组患者在术后共有5例患者发生不良反应,对照组患者中共有8例发生术后不良反应,两组患者术后不良反应发生情况差异无统计学意义(P>0.05)。结论瑞芬太尼复合异丙酚靶控静脉麻醉应用于脊柱结核手术,患者术后不良反应的发生率较低,同时对于患者的心率以及呼吸影响较小,能够较好地改善患者术后苏醒指标情况。

Objective To evaluate the anesthetic efficacy and safety of target-controlled infusion（TCI）of remifentanil combined with propofol on spinal tuberculosis surgery.Methods 80 patients with spinal tuberculosis were selected from January 2014 to December 2015 in our hospital,and were randomly divided into two groups,observation group and control group with each having 40 cases.the observation group were treated with remifentanil and propofol TCI anesthesia,the control group was treated with propofol combined with remifentanil anesthesia;compared were the spontaneous breathing recovery time,open eyes time,command of eyelash reflex recovery time,estuation time and recovery time as well as left ventricular heart rate and respiratory rate before and after treatment to improve the situation of patients between the two groups;In addition,anesthetic adverse reactions were also compared between the two groups.Results（1）after anesthesia,patients of observation group whose recovery time of spontaneous breathing,sleep time,eyelash reflection time,command recovery time,estuation time and recovery time to leave the room was[（3.12±0.35）,（6.45±1.20）,（5.12±0.45）,（9.12±2.31）,（13.56±3.12）,（17.46±3.12）min],which was significantly shorter than that of the control group [（4.56±0.41）,（8.12±2.11）,（6.89±0.18）,（10.39±0.41）,（18.45±4.01）,（19.45±4.30）min]（P〈 0.05）;（2）after anesthesia,both the heart rate and respiratory rate were found to be decreased in patients of the two groups,the observation group whose decreasing degree[（50.31±8.12）,（18.02±3.01）times/min]was significantly greater than that of the control group[（45.23±9.78）,（12.45±3.49）times/min]（P 〈0.05）;（3）a total of 5 patients were found to have postoperative adverse reaction in the observation group,whereas 8 patients were observed to have adverse reactions in the control group,there was no statistically significant difference of the incidence of adverse reactions between the two groups（P 〉0.05）.Conclusion TCI of remifentanil combined with propofol in spinal tuberculosis surgery anesthesia,which was shown to be able to improve the postoperative recovery effect of the patient＇s heart rate and breathing meanwhile the incidence of postoperative adverse reactions was also found to be relatively low.