瑞芬太尼丙泊酚麻醉对高龄手术患者循环及苏醒的影响

目的 评价瑞芬太尼丙泊酚应用于老年患者开胸术的麻醉中的有效性、安全性及可控性，并与芬太尼丙泊酚比较。方法 46例60岁以上胸部手术患者，随机分为瑞芬太尼组（R组）和芬太尼组（F组），每组23例。观察麻醉诱导、气管插管及术中的血压心率的变化、睁眼时间、拔除气管导管时间、术后疼痛情况。结果 麻醉诱导时R组低血压和心率减慢者多于F组，F组的插管反应发生率高于R组。术中R组心率和血压低于F组。在睁眼时间、拔除气管导管时间上R组明显短于F组。术毕呼吸抑制R组1例，F组7例，需给予纳络酮拮抗。所有患者于术毕前30min行硬膜外镇痛，拔除气管导管后术诉切口疼痛。两组术后恶心呕吐率无明显差异。结论 瑞芬太尼丙泊酚应用于老年患者大手术，具有麻醉诱导高血压发生率低、术中血流动力学稳定、术毕清醒早、拔管时间短等优点。

Impact of remifentanil- propofol on the circulation and awakening in senile patients under operation

To compare the anesthesia efficacy, safety and controllability of remifentanil with fentanyl in elderly patients undergoing chest operation. Methods Forty-six patients (>60 year old) undergoing upper chest operation were randomly divided into two groups: the fentanyl group (group F) and the remifentanil group (group R). Each group consisted of 23 patients. The hemodynamic changes during operation, the time of openning eyes, pulling out the tracheal tube and the post-operative pain were observed. Results When inducing of anesthesia, the blood pressure and heart rate was lower and slower in group R than that of group F. More patients in group F showed inserting tracheal response than that of group R. The blood pressure and heart rate were lower in group R than that in group F during operation. The time of openning eyes and pull out tracheal tube was shorter in group R than that in group F. Breath inhibition was observed in a case who needed naloxone for antagonising in group R and seven cases in group F. All patients underwent epidural analgesia thirty minutes before the finishing of operation without feeling cut pain after pulling out the tracheal tube. There no significant different difference in incidence in post-operation nausea and vomiting were oberved. Conclusion Remifentanil-propofol used on elderly patients undergoing large operation have the advantages of lower incidence of hypertension, high stability of hemodynamic changes, quicker recovery and shorter time of pulling out the tracheal tube as compared with that of fentanyl-propofol anesthesia.