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目的 观察瑞芬太尼全麻复合硬膜外麻醉在开胸手术中的应用效果和安全性. 方法 200例择期行开胸手术患者,ASA Ⅰ~Ⅱ级,按完全随机分组方法分为两组,瑞芬太尼组(R组)与芬太尼组(F组),均采用硬膜外复合气管插管全麻,R组与F组分别采用瑞芬太尼和芬太尼麻醉,观察术前(T0)、气管插管后1 min(T1)、5 min(T2)、切皮(T3)和术后5 min(T4)的血压、心率、血氧饱和度和血中皮质醇水平,记录术后拔管时间及患者的认知能力恢复情况. 结果 两组气管插管反应发生率相比较,F组(14/26,53.8%)明显高于R组(4/26,15.4%)(P<0.05).结论 瑞芬太尼较芬太尼能更好地抑制气管插管引起的应激反应,术后患者较早恢复认知能力,且瑞芬太尼静脉全麻复合胸段硬膜外阻滞能提供有效的镇痛和抑制手术刺激引起的血流动力学反应,术后苏醒快,有利于患者术后排痰,康复快. 相似文献
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Objective To investigate the effect and safety of remifentanil anaesthesia combined with epidural anesthesia in thoracic surgery. Methods Two hundred patients, ASA Ⅰ - Ⅱ grade, undergoing thoracotmy were randomly allocated to two groups:Remifentanil group (group R) and Fentanyl group (group F). Two groups were given combined general-epidural anesthesia. Patients in group R received remifentanil. Group F received fentanyl. The blood pressure, heart rate, blood oxygen saturation and plasma cortisol were measured before the operation (T0), 1 min (T1) and 5 min (T2) after tracheal intubation, skin incision(T3) and 5 min after the operation (T4). The endotracheal extubation time and conscious recovery were recorded. Results Compared with group R, the incidence of endotracheal intubation reaction in group F is significantly higher (group F-14/26,53.8% ;group R-4/26,15.4% ;P<0.05 ).All the patients in group R were extubated and recovered conscious completely at 7 min after operation. 6 patients in group F were extubated at 25 min after operation and 3 of them recovered recognition completely one hour later. Conclusion Remifentanil have a faster recovery after surgery than fentanyl, and it can effectively inhibit tracheal intubation stress response. Remifentanil anaesthesia combined with epidural anesthesia can provide perfect acesodyne and maintain steady circulation. 相似文献
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食管癌根治术由于手术创面较大,末梢神经丰富,术后疼痛较为严重,对病情的恢复十分不利,由于切口受呼吸运动的影响,术后疼痛剧烈且持续时间长,疼痛可影响病人咳嗽、排痰,容易引起肺不张、感染等并发症,因此术后镇痛对普胸外科病人降低术后并发症尤为重要。有效的术后镇痛可防止术后并发症的发生,改善预后。本研究比较了食管癌根治术后罗哌卡因硬膜外镇痛与芬太尼静脉镇痛的效果与不良反应,报告如下。 相似文献
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