瑞芬太尼联合丙泊酚全凭静脉麻醉在乳腺整形手术中的应用

目的探讨乳腺美容整形手术中应用瑞芬太尼（remifentanil）＋丙泊酚（propofol）联合输注全凭静脉麻醉（total intrarenous anesthesia，TIVA）方法对诱导麻醉、维持麻醉及术后苏醒过程的影响。方法ASAⅠ～Ⅱ级择期美容整形手术40例，随机分成两组（每组20例）：瑞芬太尼＋丙泊酚组及芬太尼（feutanyl）＋丙泊酚组，观察两组麻醉诱导、气管插管及术中的血压、心率变化。术毕停药后患者自主呼吸恢复时间、呼之睁眼时间、拔管时间，术后恶心、呕吐发生情况和术中知晓的发生率。结果术中瑞芬太尼＋丙泊酚组血循环稳定，血压、心率的变化与芬太尼＋丙泊酚组比较，差异有统计学意义（P〈0．05）；术毕呼之睁眼时间、拔管时间两组比较，差异有统计学意义（P〈0．05）；两组术后恶心、呕吐的发生情况无明显差异。结论瑞芬太尼＋丙泊酚联合输注TIVA用于乳腺美容整形，手术中血流动力学稳定，术后苏醒迅速。

Applicaiton of total intravenous anesthesia with remifentanil and propofol in mammary plastic surgery

Objective To investigate the clinical effects of remifentanil and propofol anesthesia in patients undergoing mammary plastic surgery. Methods Forty patients (ASA Ⅰ -Ⅱ ) were random-ized into two groups with 20 cases in each. Group R was administered remifentanil and propofol and Group F was administered fentanyl and propofol. The variation of blood pressure (BP) and heart rate (HR) during induction, endotracheal intubation and maintenance, the time of spontaneous breathing recovery, extubation, response to vebal commands, the incidence of intraoperative awareness and postoperative complications, such as vomiting and nausea, were observed. Results There were signif-icant difference in the changes of BP and HR during surgery between two groups (P<0.05). As to the tracheal extubation and the response to vebal commands, the time of group R was significantly shorter than that of group F (P<0.05). There was no significant difference in the incidence of post-operative complications, such as vomiting and nausea, between the two groups. Conclusions The he-modynamie variables are stable in the procedure of total intravenous anesthesia with remifentanil and propofol for mammary plastic surgery. The consciousness recovery is faster in remifentanil and propo-fol anesthesia. Attention should be paid on earlier postoperative analgesia setting for patients undergo-ing remifentanil and propofol anesthesia.