小剂量布托啡诺与瑞芬太尼联用对全身麻醉肾移植患者术后苏醒的影响

目的观察小剂量布托啡诺与瑞芬太尼联用对全身麻醉肾移植患者术后苏醒的影响。方法因终末期肾衰竭行肾移植术患者60例,按随机数字法分为芬太尼组(A组)、瑞芬太尼组(B组)和布托啡诺+瑞芬太尼组(C组),每组各20例。3组麻醉诱导用药及方法相同,术中均以静脉麻醉联合吸入麻醉维持麻醉。A组间断注射芬太尼0.1mg;B组以瑞芬太尼0.2～2μg/(kg.min)持续注入,手术结束时停用;C组术中麻醉维持同B组,但在关腹时静脉注射布托啡诺0.3～0.4mg。比较3组的恢复自主通气时间、苏醒时间、拔管时间、离室时间、苏醒期躁动评分及不良反应。结果 3组患者恢复自主通气的时间相近。与A组比较,B组与C组的苏醒时间、拔管时间及离室时间较短(均为P0.05)。C组苏醒期的躁动发生率明显低于A组与B组(均为P0.05)。A组1例发生恶心、呕吐,余无不良反应。结论与单用瑞芬太尼相比,小剂量布托啡诺与瑞芬太尼联用不延长苏醒时间,但能减少苏醒期躁动发生率,同时并不增加恶心、呕吐发生率。

Influence of low-dose butorphanol combined with remifentanil on palinesthesia from general anesthesia in patients undergoing renal transplantation

Objective To observe influence of low-dose butorphanol combined with remifentanil on palinesthesia from general anesthesia in patients undergoing renal transplantation.Methods Sixty patients with end-stage renal failure who underwent renal transplantation,were randomly assigned to three groups,fentanyl group（Group A）,remifentanil group（Group B）and butorphanol＋remifentanil group（Group C）.Three groups had the same premedication,induction agents and methods.Anesthesia was maintained with intravenous infusion combined with inhalation anesthesia.The patients in Group A was administered with intermittent injection of fentanyl（0.1 mg）.The patients in Group B was administrated with continuous infusion of remifentanil 0.2-2 μg/（kg·min）after induction,quitting remifentanil at the end of surgery.The patients in Group C had same maintenance compared with patients in Group B,except intravenous butorphanol（0.3-0.4 mg）was injected simultaneously while the abdomen was closed.Palinesthesia statistics including spontaneous breathing recovery time,palinesthesia time,extubation time,departure time from recovery room,emergence agitation and adverse effect were compared in three groups.Results There was no significant difference of spontaneous breathing recovery time in three groups.The time of palinesthesia,extubation time and departure time from the recovery rooms were the longest in Group A（all in P 0.05）.And the rate of emergence agitation was the lowest in Group C（all in P 0.05）.Except one case in Group A developed nausea and vomiting,no other adverse effects were observed in three groups.Conclusion Compared with use of remifentanil alone,low-dose butorphanol combined with remifentanil don＇t extend the time of palinesthesia,while significantly reduce emergence agitation without increasing the incidence of nausea and vomiting