瑞芬太尼复合七氟醚或丙泊酚麻醉效果比较

Comparison of anesthetic effect of renmifentanil combined with sevoflurane or roscopropofol

目的比较老年经输尿管镜钬激光碎石术病人瑞芬太尼分别复合七氟醚与丙泊酚的麻醉效果。方法择期全麻下行输尿管镜钬激光碎石术的老年病人51例,美国麻醉医师协会(ASA)分级为Ⅰ或Ⅱ级,随机分为瑞芬太尼复合七氟醚组(RS组)和瑞芬太尼复合丙泊酚组(RP组)。麻醉诱导:静脉注射咪达唑仑0. 05 mg/kg、丙泊酚1～2 mg/kg、顺式阿曲库铵0. 15 mg/kg、舒芬太尼0. 5μg/kg。气管插管成功后连接麻醉机行机械通气。麻醉维持:RS组静脉输注瑞芬太尼10μg/(kg·h),吸入1%～3%七氟醚; RP组静脉输注瑞芬太尼10μg/(kg·h),丙泊酚4～6 mg/(kg·h); 2组病人术中脑电双频指数(BIS)均维持在40～60。观察并比较2组麻醉诱导前(T1)、诱导后1 min(T2)、输尿管镜置入时(T3)、术毕(T4)、拔管前(T5)及出复苏室(T6)时的平均动脉压(MAP)和心率(HR);比较2组在麻醉后监测治疗室(PACU)期间舒芬太尼使用情况及不良反应的发生率;术后1 d随访,记录病人术后镇痛满意度。结果 RS组各时间点血流动力学指标差异无统计学意义; T2～T5时RS组MAP低于RP组,HR低于RP组(P<0. 05);与RP组相比,RS组在PACU期间舒芬太尼用量少(P<0. 05); 2组病人不良反应发生率及术后镇痛满意度比较,差异无统计学意义(P>0. 05)。结论瑞芬太尼复合七氟醚对输尿管镜钬激光碎石术老年病人的MAP及HR影响较小,是一种较为安全的麻醉方式。

Objective To compare the anesthetic effect of renmifentanil combined with sevoflurane or roscopropofol on uretepic holmium laser lithotripsy in the elderly. Methods A total of fifty-one elderly patients（ ASA Ⅰ-Ⅱ） undergoing ureteroscopic holmium laser lithotripsy were enrolled and randomly divided into remifentanil-sevoflurane（ RS） group and remifentanil-propofol（ RP） group. In induced anesthesia,0. 05 mg/kg midazolam,1-2 mg/kg propofol,0. 15 mg/kg cisatracurium 0. 5 μg/kg sufentanil were given in both groups. Intubated and mechanical ventilation were conducetd in all patients.In continuous anesthesia,1%-3% sevoflurane and 10 μg/（ kg·h） remifentanil were given in group RS,and 4-6 mg/（ kg·h） and 10 μg/（ kg·h） remifentanil were given in group RP. The bispectral index（ BIS） maintained 40-60 during the operation in two groups. The mean arterial pressure（ MAP） and heart rate（ HR） were observed and compared before anesthesia（ T1）,1 minute after induction（ T2）,time for ureteroscopy（ T3）,at the end of operation（ T4）,before extubation（ T5） and the time for leaving recovery room（ T6） in two groups. The application amount of sufentanil and the incidence rate of adverse reaction of two groups in postanesthesia intensive care unit（ PACU） and the satisfaction of anesthesia 1 d after operation were also compared. Results There were no significant differences in MAP and HR at each time point in group RS. MAP and the HR were significantly lower in group RS than those in group RP at T2-T5. The application amount of sufentanil in group RS was fewer compared with the group RP in PACU,and there were no significant difference in the incidence rate of adverse reaction and the satisfaction of anesthesia between the two groups. Conclusions Remifentanil combined with sevoflurane is a safe anesthesia method with less effect on MAP and HR for the elderly with uretepic holmium laser lithotripsy.