瑞芬太尼全麻复合硬膜外麻醉在食管癌根治术中的应用

目的观察和分析瑞芬太尼全麻复合硬膜外麻醉在食管癌手术中的应用效果。方法60例择期行食管癌根治术患者，ASA I～Ⅱ级，随机分组分为3组，瑞芬太尼组（R组）、瑞芬太尼＋硬外组（RE组）和芬太尼＋硬外组（FE组）。RE组和FE组全麻诱导前行硬膜外麻醉，麻醉维持：RE组和R组静脉输注瑞芬太尼，FE组静脉输注芬太尼。记录术中阿片类用药量、术后拔管时间、血压和心率变化、OAA／S评分、VAS评分及躁动情况。结果与R组比较，RE组术中瑞芬太尼用药量减少．术后VAS评分和躁动概率降低。与FE组比较，RE组术后OAA／S评分明显升高（P〈0．05）。结论瑞芬太尼全麻复合硬膜外麻醉能减少术中阿片类药物用量，术后苏醒快，苏醒质量好，镇痛效果好，是较好的麻醉方式。

Application of Remifentanil anesthesia combined with epidural anesthesia in radical operation for esophageal cancer

Objective To observe and analyze the effect of remifentanil anaesthesia combined with epidural anesthesia in esophageal carcinoma operation.Methods Sixty patients(ASA Ⅰ-Ⅱ) with esophageal carcinoma undergoing radical esophagectomy were randomly divided into 3 groups,remifentanil group(group R),remifentanil anaesthesia combined with epidural anesthesia(group RE) and fentanil anaesthesia combined with epidural anesthesia(group FE).Group RE and group FE received epidural anesthesia before induction of anesthesia.Group RE and group R were maintained with remifentanil,group FE was maintained with fentanil.The opioid drug usage during surgery,extubation time,the changes of blood pressure and heart rate,OAA/S score were recorded.Results Compared with group R,the remifentanil drug usage during surgery,vas score and restlessness condition after operation in group RE was reduced,compared with group FE,OAA/S score were significantly higher in group RE(P < 0.05).Conclusion Remifentanil anaesthesia combined with epidural anesthesia can reduce the opioid drug usage during surgery,the patients waked up earlier,and it can obtain good recovery quality and analgesic effect after operation,it is a better anesthetic method.