瑞芬太尼全麻与硬膜外复合全麻用于开胸手术的对比研究

目的:比较胸科手术中瑞芬太尼全麻与硬膜外阻滞复合全麻围术期血流动力学的变化、麻醉深度及术毕清醒情况。方法:60例择期行开胸手术患者,随机分为两组,瑞芬太尼全麻组(R组)异氟醚吸入复合静脉泵注瑞芬太尼全麻组;硬膜外复合全麻组(E组)异氟醚吸入全麻复合胸段硬膜外阻滞组。记录两组患者围术期BP、HR及脑电双频谱指数(BIS)、清醒时间的变化。结果:R组病人围术期的血压、心率稳定,E组病人血压下降较大,在麻醉维持期间R组BIS显著低于E组,两组患者从手术结束到呼之睁眼和拔除气管导管时间相似。结论:瑞芬太尼全麻与硬膜外复合全麻在胸科手术中都能提供有效的镇痛和抑制手术刺激引起的血液动力学反应,但瑞芬太尼全麻术中不但血流动力学稳定而且麻醉深度更佳。

Comparative study of remifentanil versus epidural anaesthesia in thoracic surgery with isoflurane

Objective:To compare the peri-operative hemodynamic variability, depth of anesthesia and recovery profile of anesthesia of remifentanil versus epidural anaesthesia in thoracic surgery with isoflurane. Methods: 60 patients, scheduled for elective thoracic surgery were randomly allocated to receive either intravenous remifentanil (group R) or epidural block (group E) with isoflurane for their anesthesia. The perioperative changes of BP,HR, bispectrum index and recovery profile of anesthesia were recorded respectively. Results: In group R , BP and HR were stable, but in group E, a greater BP decrement was observed. BIS during maintenance of anesthesia in group R were significantly lower than that in group E. The time duration to opening eyes on command and the time for extubation after surgery were similar between the two groups. Conclusion: Remifentanil was as effective as epidural block in providing analgesia and suppressing hemodynamic responses to thoracic surgery under isoflurane anaesthesia. But under Remifentanil anaesthesia the hemodynamic change was stable and depth of anesthesia was more preferable.