芬太尼和瑞芬太尼用于肾移植麻醉的比较

目的比较肾移植麻醉时使用芬太尼、瑞芬太尼时安全性和有效性。方法36例患者随机分为芬太尼组和瑞芬太尼组。观察血流动力学变化;术毕自主呼吸恢复时间,呼之睁眼时间,拔管时间,定向力恢复时间;观察拔管后即刻、拔管后30 min1、h3、h和24 h的意识状态(OAAS),认识功能测试(MMSE);观察术后不良反应的发生率等。结果麻醉诱导期瑞芬太尼组患者血流动力学变化幅度显著小于芬太尼组(P<0.05)。瑞芬太尼组患者自主呼吸恢复时间,呼之睁眼时间,拔管时间,定向力恢复时间均早于芬太尼组(P<0.05)。瑞芬太尼组拔管后即刻、拔管后30 min1、h、3 h的OAAS及MMSE评分均高于芬太尼组(P<0.05)。结论瑞芬太尼麻醉诱导更加平稳,术中血流动力学稳定,苏醒质量优良。

Comparison of fentanyl and remifentanil in kidney transplant surgery

Objective To compare the hemodynamics during induction and maintenance of anesthesia and recovery profiles using fentanyl or remifentanil with isoflurane inhalation anesthesia in kidney transplant surgery.Methods 32 patients underwent renal transplantation were randomly divided into fentanyl group or remifentanyl group with 16 cases in each group.Anesthesia was induced with propofol（2 mg/kg） and either fentanyl（2.5 μg/kg） or remifentanil（2 μg/kg）,and was maintained with isoflurane inhalation anesthesia and a continuous infusion of either fentanyl[0.03 μg/（kg·min）] or remifentanil[0.2 μg/（kg·min）].The hemodynamic changes of patients at different stages of anesthetic and surgical procedures and recovery profiles were compared.Results The hemodynamic changes of patients at different stages of anesthetic and surgical procedures in the remifentanil group were significantly smaller than those in the fentanyl group（P0.05）.Times from stopping administration of anesthetics until full spontaneous respiration,eye opening,extuibation,and orientation were significantly less in the remifentanil group than in the fentanyl group（P0.05）.The observer′s assessment of alertness/sedation（OAAS） scores and the mini mental states scores（MMSE） at tracheal extubation,30 min,1 h and 3 h after extubation were higher in the remifentanil group than in the fentanyl group（P0.05）.There was no significantly difference between the two groups in the aspect of adverse reactions.Conclusion Remifentanil with isoflurane inhalation anesthesia in kidney transplant surgery is associated with better hemodynamic stability and recovery profile compared with fentanyl.