3种阿片类镇痛药分别与丙泊酚持续靶控输注用于脊柱手术的疗效比较

目的:3种不同的阿片类镇痛药分别复合丙泊酚用于脊柱手术麻醉,通过统计术中、术后的有关参数,比较其优劣。方法:75例脊柱手术的病例随机分为:芬太尼组(Ⅰ组25例),舒芬太尼组(Ⅱ组25例)和瑞芬太尼组(Ⅲ组25例)。诱导时各药靶浓度为:芬太尼3ng/mL,瑞芬太尼4.0ng/mL,舒芬太尼0.5ng/mL,丙泊酚3μg/mL。术中维持:丙泊酚浓度不变,芬太尼2～4ng/mL,瑞芬太尼2～6ng/mL,舒芬太尼0.2～1ng/mL。监测血流动力学、麻醉并发症,进行术后VAS疼痛评分及OAAS意识评分。结果:3组患者的基础MBP、HR无显著性差异(P>0.05);Ⅰ组在切皮、椎管内手术各期、缝皮和拔管期时的MAP和HR均明显高于基础值(P<0.05),Ⅱ组整个麻醉过程的MAP和HR均低于基础值(P<0.05),Ⅲ组参数时有波动;Ⅱ组维持镇痛时间最长,Ⅲ组最短;Ⅱ组在同时间点的OAAS评分Ⅱ组最低,Ⅲ组最高;术后Ⅰ组的恶心呕吐率(PONV)明显高于Ⅱ、Ⅲ组(P<0.05),Ⅱ组延迟性呼吸抑制5例。结论:在脊柱手术中,以舒芬太尼复合丙泊酚持续靶控输注的麻醉效果最为理想,并发症最少,但考虑到舒芬太尼的积蓄性,建议提前半小时停药;而瑞芬太尼又优于芬太尼。

Comparison of effects of sustained target-controlled infusion with three opioid analgesics and propofol on spinal surgery

Objective:To compare the effect of three different opioid analgesics on spinal surgery as combined with propofol.Methods:75 cases with spinal surgery were randomly separated into three groups,fentanyl group(Ⅰ),sufentanil group(Ⅱ)and remifentanil group(Ⅲ),with 25 patients per group.Induction concentrations of target drugs were as following:fentanyl 3.0 ng/mL,remifentanil 4.0 ng/mL,sufentanil 0.5 ng/mL,propofol 3 μg/mL.Sustention concentrations during surgery were fentanyl 2-4 ng/mL,remifentanil 2-6 ng/mL,sufentanil 0.2-1 ng/mL,propofol 3 μg/mL.Monitored hemodynamics and anesthesia complication,and made postoperative VAS pain score and OAAS consciousness score.Results:Basic level of MBP,HR in three groups had no significant difference(P>0.05).MAP and HR in groupⅠwere higher than basic level during skin incision,all periods of spinal surgery,skin suture and extubation(P<0.05),the HR and MAP of group Ⅱ in the whole anesthesia process were lower than the basic level(P<0.05),and the indices of groupⅢ fluctuated sometimes.Besides,group Ⅱhad the longest analgesic time and the group Ⅲ the shortest.At the same time,OAAS score showed that the lowest point appeared in the group Ⅱ,and the highest in the group Ⅲ.The postoperative nausea and vomiting(PONV)in groupⅠwas significantly higher than group Ⅱand Ⅲ(P<0.05),and 5 cases had delayed respiratory depression in group Ⅱ.Conclusion:Target-controlled infusion with combination of sufentanil and propofol has the most satisfactory effect on spinal surgery,and has the least complication.However,concerning accumulation of sufentanil,it is suggested that administration should be halted half an hour ahead.And remifentanil is more effective than fentanyl in this respect.