瑞芬太尼 芬太尼及瑞芬太尼复合全麻的对照研究

目的 对比研究瑞芬太尼、芬太尼复合瑞芬太尼在全麻术中应用的可行性和有效性。方法 ASAⅠ～Ⅱ级腹部胃肠道手术患者60例随机分为三组：F、R组和RF组，每组20例。F组血浆靶控芬太尼术中镇痛，芬太尼血浆靶浓度根据手术刺激调整，手术结束前半小时停止；R组用瑞芬太尼替代芬太尼；RF组瑞芬太尼复合芬太尼，胃肠道吻合操作完成前主要由芬太尼维持镇痛，其后主要由瑞芬太尼维持镇痛。结果 R组诱导时发生呛咳、肌肉强直、心动过缓均比其余两组多。R组苏醒期MAP和HR与其余两组相比明显增高（P〈0．05）。苏醒期R组发生躁动、高血压、心动过速均比其余两组增多明显。与F组相比，R和RF组拔管时间、出恢复室时间明显缩短（P〈0．05）。RF组瑞芬太尼用量与R组相比明显减少（P〈0．05），RF组芬太尼用量与F组相比明显减少（P〈0．05）。R、RF组的拔管后即刻、离开PACU、拔管后1hOAA／S评分明显比F组高（P〈0．05）。RF组患者拔管后即刻、离开PACU时疼痛评分与R组相比，差异显著（P〈0．05）。结论 三种麻醉方法术中均能提供良好的镇痛，满足手术要求。但瑞芬太尼联合芬太尼既能提供完善的镇痛，维持术中血流动力学平稳，术毕又能苏醒迅速且苏醒质量高。

The comparative study of using remifentanil、fentanyl and remifentanU in general anaesthesia

Objective To make a comparative study on the feasibility and validity of using remifentanil, fentanyl and remifentanil in general anaesthesia. Methods 60 ASA class Ⅰ～Ⅱ patients undergoing abdomen operations were randomly divided into three groups： group F,group R and group RF with 20 cases in each group. In group F, analgesia was induced and maintained with TCI fentanyl. The target plasma concentration of fentanyl was adjusted based on operation stimulation and stoppet at 30min before the end of surgery. In Group R,fentanyl was replaced by remifentanil. In Group RF, analgesia was induced and maintained with TCI remifentanil - fentanyl , analgesia was maintained with fentanyl before gastrointestinal tract anastomosis and with remifentanil afterwards. Results The occurrence of cough,muscle twitch,bradycardia in group R were more than other two groups during inducement. MAP and HR in group R were significanfly higher than other two groups during recovery from anesthesia（ P 〈 0.05） .The occurrence of fidget, hypertension, tachycardia were more than other two groups during recovery from anesthesia（ P 〈 0.05）. The duration from termination of anesthesia to trachea extubation and the stay in PACU was significantly shorter in group R and group RF than in group F（ P 〈 0.05）. The quantity of remifentanil used in group RF was significantly lower than in group R and the quantity of fentanyl used in group RF was significantly lower than in group F（ P 〈 0.05 ）. The OAA/S scores were significantly greater in group R and group RF than in group F at the time point of trachea extubation,leaving PACU and lh after trachea extubation（ P 〈 0.05） .The ache scores in group R were greater than in group RF at the time point of trachea extubation and leaving PACU. Conclusions Three methods can all provide perfect acesedyne and match operations. Anaesthesia with TCI remifentanil and fentanyl not only can provide perfect acesodyne, maintain steady circulation but also can have a faster recovery from gene