雷米芬太尼复合丙泊酚与芬太尼复合异氟醚在实施心脏手术快通道麻醉的比较

目的比较雷米芬太尼复合丙泊酚与芬太尼、丙泊酚复合异氟醚用于不停跳心脏手术患者麻醉的应激激素及血流动力学变化。方法26例患者随机均分为雷米芬太尼复合丙泊酚(RP组)和芬太尼复合异氟醚(FI组)两组。分别记录不同时点HR、MAP和血糖(Glu)数值,同时观察相应时点血浆皮质醇(Cor)及促肾上腺皮质激素(ACTH)反应。结果两组患者各观察点血流动力学及应激激素变化组间比较差异无统计学意义。两组患者血浆Cor、ACTH、Glu在心肺转流(CPB)后15min、停CPB后10min与诱导前比较差异有统计学意义(P<0.01),RP组患者术后清醒时间及拔管时间明显早于FI组(P<0.01),但ICU留观时间组间比较差异无统计学意义,且RP组术后疼痛发生率高于FI组(P<0.05)。结论雷米芬太尼复合丙泊酚实施不停跳心内直视手术麻醉,可维持术中血流动力学平稳,停药后清醒快,符合快通道心脏手术麻醉要求,但应加强术后镇痛。

Comparison of remifentail-propofol with fentanyl-isoflurane anesthesia for fast track cardiac surgery

Objective To compare the effects of anesthesia with remifentail-propofol(RP) and with fentanyl-propofol-isoflurane inhalation(FI) for off-pump heart surgery on stress response and hemodynamic changes.Methods Twenty-six patients were divided into group RP and group FI.HR and MAP were recorded and blood samples were taken for the measurements of concentrations of blood glucose(Glu),ACTH and serum cortisol(Cor) during operation.Results There were no signigicant differences in hemodynamics and Cor,ACTH and Glu between the two groups during anesthesia,but the levels of Cor,ACTH and Glu at 15 min during CPB and 10 min after the end of CPB were higher than those before intubation(P<0.01).Recovery from anesthesia and extubating time were earlier in group RP than that in group FI(P<0.01),however,there was no significant difference in the length of stay in ICU between the two groups.The patients in group RP had higher visual analog scores(VAS) than those in group FI(P<0.05).Conclusion Remifentanil anesthesia can offer hemodynamic stability during off-pump heart surgery.It is effective to decrease stress response and fit the demand of fast track anesthesia.But postoperative analgesia should be stressed.