异丙酚复合瑞芬太尼与异丙酚复合芬太尼靶控静脉麻醉的临床比较

目的 评价异丙酚和瑞芬太尼靶控静脉麻醉诱导和术后苏醒过程.方法 ASA Ⅰ、Ⅱ级择期行腹腔镜胆囊切除手术病人40例,随机分为异丙酚瑞芬太尼靶控组(R组)和异丙酚芬太尼靶控组(F组),每组20例.观察麻醉诱导及气管插管时的血压、心率,记录术毕停药后病人自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间和离开恢复室时间;观察病人拔管后即刻、离开恢复室、拔管后1、3和24 h的意识状态(OAAS),认知功能测试(MMSE),疼痛评分(VRS)及主诉需要阿片药镇痛的时间;观察恶心呕吐等副反应,记录术中知晓的发生率和病人满意度等.结果 F组的插管反应发生率明显高于R组(P＜0.05);两组病人术后自主呼吸恢复时间、呼之睁眼时间、拔管时间差异无显著性(P＞0.05),R组病人在拔管后即刻、离开PACU时、拔管后1 h和术后24 h的VAS评分明显高于F组(P＜0.05),需要阿片药镇痛者R组明显多于F组(P＜0.05);两组病人术后的恶心呕吐发生率差异无显著性(P＞0.05).结论 异丙酚瑞芬太尼靶控静脉麻醉诱导更加平稳,但苏醒质量不如异丙酚芬太尼靶控静脉麻醉优良,术后需及时镇痛.

Clinic comparison of anesthesia of target-controlled with infusion of between propofol-remifentanil and propofol-fentanil

Objective] To evaluate the induction of and recovery from anesthesia with target-controlled infusion (TCI) of propofol-remifentanil. Methods] Fourty ASA I~II patients 40 undergoing elective laparoscopic cholecystectomy were randomly divided into two groups of 20 patients: group R and F. In group R anesthesia was induced and maintained with TCI propofol-remifentanil. In group F anesthesia was induced and maintained with TCI propofol-fentanyl. MAP, DBP, SBP, HR, ECG, SpO2 and PetCO2 were monitored during anesthesia. The following were recorded and compared between the 2 groups: the changes in MAP and HR during induction and tracheal incubation; recovery of spontaneous breathing and orientation after termination of anesthesia; the duration of stay in PACU; OAAS scores after operation; postoperative cognitive outcome, pain and complications like nausea and vomiting; awareness during operation. Results] The incidence of intubation response was higher in group F than that in group R (P <0.05). The duration from termination of anesthetics to full recovery of spontaneous breathing, eye opening at request and tracheal extubation were similar between the two groups. VRS score after operation was significantly higher in group R than that in group F. The incidence of postoperative nausea and vomiting was similar between the two groups. Conclusion] Induction of anesthesia with TCI of propofol-remifentanil is hemodynamically more stabler. However, recovery from anesthesia of TCI propofol-fentanil is better than that with TCI propofol-remifentanil. Postoperotive analgesia should be gived in group R in time.