瑞芬太尼全凭静脉麻醉用于老年危重患者的评价

目的探讨瑞芬太尼在老年危重患者临床麻醉中的应用效果及可行性。方法 ASAⅡ～Ⅲ级老年患者70例随机分为两组每组35例。Ⅰ组为瑞芬太尼组:瑞芬太尼0.5μg/(kg·min)泵注诱导、0.2μg/(kg·min)泵注维持;Ⅱ组为芬太尼组:芬太尼3μg/kg静注诱导、0.03μg/(kg·min)泵注维持。术中监测ECG、MAP、SpO2、PETCO2,并记录术中HR、MAP以及停药后自主呼吸、意识、定向力恢复时间、拔管时间及不良反应。结果诱导后两组病人HR、MAP均显著降低(P<0.01)。插管即刻及插管后、探查时Ⅰ组的所有患者均接近诱导前水平,Ⅱ组HR、MAP升高幅度显著>Ⅰ组,停药15min后Ⅰ组患者均恢复自主呼吸,而Ⅱ组较Ⅰ组意识及定向力恢复、拔管时间明显延迟,Ⅰ组与Ⅱ组比较差异具有统计学意义(P<0.05)。结论瑞芬太尼可安全用于老年患者,循环稳定,效价比高,应激反应抑制良好,苏醒快,但无术后镇痛作用。

Evaluation of remifentanil on elderly critical patients during intravenous anesthesia

Objective To investigate the effects of remifentanil on elderly critically ill patients during clinical anesthesia and its fea-sibility.Methods Seventy elderly patients with ASA Ⅱ-Ⅲ were randomly divided into two groups (n=35 per group) ,i.e.remifentanil group [Group A,0.5 μg/(kg·min) induced,0.2 μg/(kg·min) maintained]and fentanyl group[group B,3 μg/ (kg·min) induced,0.03 μg/(kg·min) maintained].ECG,MAP,PETCO2 and SpO2 were monitored.HR and MAP in intrao-perative,recovery time of spontaneous breathing,consciousness and directional forces,time of decannulation,and adverse reaction after discontinuation were recorded.Results HR and MAP were significantly lower after induction than before in all the patients of the two groups (P<0.01) .The parameters of HR and MAP immediately after intubation and after intubation and during surgical operation were close to that before induction in Group A,but in Group B they rose significantly.In Group A,autonomic breathing recovered in 15 min after discontinuation.In Group B there existed an obviously delay in consciousness,directional power recovery and decannulation time (P<0.05) .Conclusion Remifentanil is safe for elderly patient,because of circulatory stabilization,satisfactory analgesic effect,good suppression on stress reaction,fast revival except postoperative analgesia.