瑞芬太尼复合丙泊酚麻醉在脑肿瘤术中的应用

目的探讨瑞芬太尼（RF）复合丙泊酚在脑肿瘤手术麻醉中的应用价值。方法ASAI-Ⅲ级在全麻下择期手术患者120例，随机分为RF组和芬太尼组，每组60例。麻醉诱导：静脉注射注咪唑安定＋维库溴铵＋依托咪酯＋RF（或芬太尼），麻醉维持采用持续泵注RF（或芬太尼）＋丙泊酚。观察并记录2组患者入手术室时、插管前即刻、插管后1min、插管后10min和拔管各个时段的血流动力学变化、麻醉恢复情况（自主呼吸恢复时间、睁眼时间和拔管时间）以及苏醒期间使用镇痛药和躁动情况。结果血流动力学变化：与基础值比较，2组均在诱导后下降，插管后1min芬太尼组升高，RF组在拔管时升高，差异有统计学意义（P〈0.05）。麻醉恢复情况：RF组早于芬太尼组；镇痛药使用RF组多于芬太尼组；RF组患者躁动少于芬太尼组，差异有统计学意义（P〈0.05）。结论RF相对于芬太尼用于脑肿瘤手术中全身麻醉更具优势，其麻醉平稳、血流动力学稳定、苏醒快、完全，有利于早期拔管。由于药物代谢快，疼痛出现早，需及时给予必要的术后镇痛。

The value of remifentanil combined with propofol anesthesia applied in cerebral tumor surgery

Objective To discuss the clinical value of remifentanil （RF） combined with propofal anesthesia applied in cerebral tumor surgery. Methods 120 eases of patients of ASA I-Ⅲ level under full anesthesia for operation upon a selected date were randomly divided into RF group and fentanyl group. Anesthesia induction：intravenous injection of imidazole ＋ veeuronium bromide ＋ etomidate ＋ RF （or fentanyl）. Anesthesia maintenance applied continuous pumping injection of RF （ or fentanyt） ＋ propofal. Observed and recorded bemodynamics changes, anesthesia recovery situation （ self breathing recover time ,eye-opening time and tube removing time） of patients in the two groups when entering the operation room ,right before inserting the tubes, 1 minute after inserted tubes, 10 minutes after inserted tubes and tube removing,as well as the application of analgesic during consciousness and agitation. Results Hemodynamics changes ： compared with the basic value, hemodynamics declined after induction. Hemodynamics of fentanyl group increased in 1 minute after inserted tubes, while the RF group increased when removing the tubes, the difference was statistically significant （P〈0.05）. Recovery of anesthesia：compared the fentanyl group the recovered of RF group was earlier, the applied of analgesic was more, while the agitation of patients were less, the difference was statistically significant （P〈0.05）. Conclusion RF had more advantages than fentanyl applied in cerebral tumor surgery, such as smooth anesthesia, stable hemodynamics,early and full reviving and favorable for early tube removing. As the metabolism of anesthesia was quick, and pain appeared early, it is necessary apply analgesic after operation.