持续输注舒芬太尼和瑞芬太尼静脉麻醉用于妇科腔镜手术的比较

目的观察持续输注瑞芬太尼和舒芬太尼复合异丙酚全凭静脉麻醉在妇科腔镜手术中的应用效果。方法 60例拟行妇科腔镜手术病人随机分为R组（输注瑞芬太尼）和S组（输注舒芬太尼）。R组麻醉诱导瑞芬太尼0.5μg/kg.min输注2 min,随后TCI输注异丙酚,靶浓度为4μg/ml。S组诱导单次注射0.5μg/kg舒芬太尼,再以0.5μg/kg.min输注5 min后,随后TCI输注异丙酚,靶浓度为4μg/ml。手术结束前20 min关闭舒芬太尼输注,手术结束时关闭瑞芬太尼输注。观察记录术中MAP、HR、清醒时间、异丙酚使用量、疼痛发生率、术后恶心呕吐（PONV）,复苏室中呼吸抑制发生率以及复苏室停留时间。结果 S组术中MAP较R组高（P〈0.01）;R组中术后疼痛发生率和PONV较S组高（P〈0.01）,R组病人恢复室停留时间较S组长（P〈0.01）。结论舒芬太尼和瑞芬太尼麻醉都可提供较好麻醉效果。舒芬太尼能提供较好的术后镇痛,可减少术后镇痛药用量,还可减少PONV发生和缩短恢复室停留时间。

A comparative study for continuous infusion of remifentanil and sufentanil in videolaparoscopic surgery in gynecology

Objective To compare two techniques of total intravenous anesthesia,using continuous infusion（CI） of remifentanil or sufentanil,undergoing videolaparoscopic surgeries in gynecology.Methods 60 patients were divided into 2 groups（RG and SG）.Continuous infusion of remifentanil was used for anesthetic induction in RG,while a bolus of sufentanil associated with CI of this drug was used in SG.The CI of remifentanil was discontinued at the end of the surgery,while the CI of sufentanil was discontinued 20 minutes before the end of the surgery.Tramadol was used for rescue analgesia in the recovery room.Variations of mean arterial pressure（MAP） and heart rate（HR）,time for awakening,propofol consumption,intercurrences in the recovery room,and time of stay in the recovery room were analyzed.Results MAP in SG was greater than that in RG（P0.01）.The incidence of pain in RG was significantly higher than that in SG（P0.01）.The incidence of postoperative nausea and vomiting（PONV） in RG was higher than that in SG（P0.01）.The time of stay in the recovery room in RG was longer than that in SG（P0.01）.Conclusion Infusion of sufentanil promotes better postoperative pain control with decreased consumption of rescue analgesic and,consequently,reduces incidence of PONV and time of stay in the recovery room.