瑞芬太尼与芬太尼在神经外科手术中应用的对比

目的 瑞芬太尼是新一代人工合成的超短效能的阿片μ受体激动药,该文意在对比瑞芬太尼与芬太尼在神经外科手术的应用中循环稳定性与术终意识恢复程度。方法 30例择期神经外科手术病人,随机分为：R组，瑞芬太尼浓度(10µg ml–1)剂量(2µg kg–1)；F组，芬太尼浓度(25µg ml–1)剂量(3-4µg kg–1)进行气管插管。气管插管完成5 min后，各组持续泵入瑞芬太尼或芬太尼，在上头架、切皮、开颅、关颅、缝皮时，术中静脉追加瑞芬太尼或芬太尼维持血流动力学稳定。F组在缝皮结束时停药；R组在拿掉头钉、拿走头架后停药。分别于入室(基础值)、诱导最低值、插管、上头架、切皮、开颅、关颅、卸头架、拔管记录收缩压(SBP)、舒张压(DBP)、心率(HR)、 SpO2，记录病人停药后拔管时间和意识恢复时间。结果 与基础值比较，二组患者SBP、DBP和HR在麻醉诱导时均降低。插管和拔管后，F组循环变化较大，R组循环无明显变化。术中各阶段R组的SBP、DBP和HR低于F组。R组术终苏醒更迅速，拔管早、意识恢复快。结论 在神经外科手术中，应用瑞芬太尼，可迅速调整麻醉深度，达到有效镇痛并抑制麻醉操作和手术刺激所引起的心血管反应，又能使患者迅速清醒。v

Remifentanil vs fentanyl in Neurosurgery

【Abstract】 Objective Remifentanil hydrochloride is a new ultra–short–acting μ–0pi0id receptor agonist with rapid onset and offset of action. This study compared the use of remifentanil with that of fentanyl in Neurosurgery and evaluated the hemodynamic condition and the quality of recovery from anesthesia. Methods Thirty adult patients were randomized into two groups: in group R with remifentanil concentration(10µg ml–1) dose(2µg kg–1) for intubation and pumping dose(0.2µg kg–1 min–1) boost（0.85µg kg–1）during surgery, in group F analgesia was provided with fentanyl concentration(25µg ml–1) dose(3-4µg kg–1) for intubation and pumping dose(0.03µg kg–1 min–1) boost（1µg kg–1）during surgery to maintain stable hemodynamics. Anesthesia was induced with midazolam, propofol and pipecuronium bromide, and maintained with isoflurane, pipecuronium and fentanil(group F) or remifentanyl(group R), respectively. Hemodynamics and recovery time was monitored. Results Baseline hemodynamics were similar in both groups. Cardiovascular responses during oral intubation and extubation in group R were less than that in group F. SBP,DBP and HR of group R were lower than those of group F. Patients in group R exhibited a faster recovery. Conclusion Remifentanil appears to be a reasonable alternative to fentanyl during elective neurosurgery. Applying in craniotomy remifentanil provides stable hemodynamic condition，shorter recovery time and higher recovery quality．Thus neurological function evaluation can be performed, much earlier.