瑞芬太尼联合丙泊酚用于老年开胸患者全凭静脉麻醉的效果分析

目的评价瑞芬太尼联合丙泊酚用于老年开胸患者全凭静脉麻醉的临床效果。方法 60例拟行开胸手术的老年患者,ASA分级为Ⅰ~Ⅱ级,随机分为瑞芬太尼组(R组),和芬太尼组(F组),每组各30例。麻醉诱导:R组采用咪唑安定0.05 mg/kg,丙泊酚2 mg/kg,瑞芬太尼1μg/kg,维库溴铵0.1 mg/kg。F组采用芬太尼3μg/kg,代替瑞芬太尼。气管插管行机械通气。麻醉维持:R组持续泵注瑞芬太尼0.1~0.3μg/(kg.min),丙泊酚3~4 mg/(kg.h)。F组芬太尼0.03~0.05 mg/(kg.min),丙泊酚3~4 mg/(kg.min)持续泵入,两组均间断静脉注射维库溴铵0.03 mg/kg。R组在手术结束前10 min停止泵入丙泊酚,在手术结束时停止泵入瑞芬太尼。F组在手术结束前25 min停止泵入芬太尼,手术结束前10 min停止泵入丙泊酚。结果 R组诱导时血压下降幅度明显小于F组。麻醉维持期间,R组血流动力学变化小于F组。结论瑞芬太尼联合丙泊酚全凭静脉麻醉用于老年开胸患者麻醉效果好,对患者的心率及血压改变不明显,术毕苏醒迅速。

Efficacy of aged thoracotomy with remifentanil combined with propofol in total intravenous anesthesia

Objective To observe the efficacy of aged thoracotomy with remifentanil combined with propofol in total intravenous anesthesia.Methods Sixty aged patients,ASAI-II,remifentanil 1 μg/kg was infused(group R,n=30),which was combined with propofol 2 mg/kg,midazolam 0.05mg/kg and vecuronium bromide 0.1mg/kg during inducing for anesthesia.The fentanil 3ug/kg was infused(group F,n=30),which was combined with the same medicines above about.After inducing for anesthesia,all the aged were inserted pipe in their thachea,starting ventilation..The group R were continually infused remifentanil 0.1~0.3 μg/(kg·min) and propofol 3~4 mg/(kg·h) by micro-pump,stopped propofol infusion as 10 minutes before the children surgery operation acompleted,stopped remifentanil infusion before operation acompleted.The gyoup F were continually infused fentanil 0.03~0.05 mg/(kg·min) and propofol 3~4 mg/(kg·h) by micro-pump,stopped fentanil infusion as 25 minutes before operation acompleted,stopped propofol infusion as 10 minutes before operation acompleted.Two groups were intermitently infused vecuronium bromide 0.03 mg/kg.Results During inducing for anesthesia,the group R was reduced in BP change than the group F.During anesthesia continuous,the group R was reduced in BP,SPO2,MAP,CVP and HR change than the group F.Conclusion Remifentanil combined with propofol in aged thoracotomy may increase the anesthesia effect and merit further popularization.