瑞芬太尼对地氟醚全麻诱导和喉罩置入MAC的影响

Effects of remifentanilon on desflurane anesthesia induction and laryngeal mask airway insertion with MAC

目的探讨瑞芬太尼对地氟醚全麻诱导和喉罩置入患者最低肺泡有效浓度(Minimum alveolar concentration,MAC)的影响。方法选取2014年1月~2016年12月我院收治的150例喉罩置入全麻手术患者为研究对象,将患者采用数字随机表法分为D1组、D2组、D3组,每组50例。D1组采用地氟醚吸入行全麻诱导,D2组采用大剂量瑞芬太尼联合地氟醚行全麻诱导,D3组采用小剂量瑞芬太尼联合地氟醚行全麻诱导。比较三组患者全麻诱导后的意识消失时间、咳嗽发生率、喉痉挛发生率、最低肺泡有效浓度(MACEI50),并比较三组患者全麻诱导前后的心率和平均动脉压。结果全麻诱导后,三组患者的意识消失时间比较,差异无统计学意义(P>0.05);但D2组、D3组的咳嗽发生率、喉痉挛发生率较D1组明显减少(P<0.05)。D1组全麻诱导后的心率、平均动脉压升高显著(P<0.05),而D2组、D3组麻醉诱导后的心率、平均动脉压无明显升高(P>0.05)。麻醉诱导后,D2组、D3组的最低肺泡有效浓度与D1组比较明显降低,差异有统计学意义(P<0.05)。结论采用瑞芬太尼与地氟醚行复合麻醉诱导,可有效减轻患者的气道和心血管应激反应,有效降低地氟醚的最低肺泡有效浓度,在保证麻醉效果的前提下,尽量选择小剂量瑞芬太尼。

Objective To study and explore how remifentanil effects on Desflurane anesthesia induction and laryngeal mask airway insertion with minimum alveolar concentration（Minimum alveolar concentration,MAC）.Methods From January 2014 to Dem-ber 2016,we choose 150 patients of our hospital,undergoing laryngeal mask airway insertion surgery with general anesthesia in this period as the research subjects.Accor-ding to the digital random table,we divided the patients into three groups：group D1,group D2 and group D3 and 50 members in each group.Group D1 was anesthesia in-duced with desflurane,group B with large doses of remifentanil and desflurane and group D3 with small dose of remifentanil and desflurane.The consciousness disap-pearance time,the cough incidence,the incience of laryngeal spasm and the minimum alveolar＇s effective concentration（MACEI50）were compared among the three groups after anesthesia induction.And the heart rate and mean arterial pressure before and after anesthesia induction were compared too. Results The comparison of consciousness time was of no difference in Statistics after anesthesia induction（P〉0.05）.While the rate of cough incidence and throat spasm of group D2 and group D3 was signific-antly lower than that of group A（P〈0.05）.The heart rate and mean arterial pressure increased significantly in group A（P〈0.05）;which did not appear significant increase in group D2 and group D3（P〉0.05）.And the minimum alveolar concentration of them were significantly lower comparing to group A D2（P〈0.05）. Conclusion Using re-mifentanil and desflurane as a combined anesthesia induction,it can alleviate the patients stress reaction to the airway and cardiovascular effectively,which can also reduce the minimum alveolar concentration of desflurane.Under the guarantee of the anesthesia effect,it is better to choose a small dose of remifentanil.