目的比较瑞芬太尼和芬太尼对异丙酚静脉麻醉作用的影响.方法选择110例择期手术患者,分别采用异丙酚(P组,n=30)、异丙酚芬太尼(PF组,n=52)靶控输注或者异丙酚靶控输注复合瑞芬太尼(PR组,n=28)持续输注全静脉麻醉.芬太尼靶浓度2 μg/L,瑞芬太尼麻醉诱导和维持分别为0.25～0.5及0.125～0.25μg(kg·min),异丙酚初始靶浓度为1 mg/L,逐渐增加靶浓度值直至意识消失.术中调整异丙酚、芬太尼靶浓度值或瑞芬太尼输注速度维持麻醉深度.观察血流动力学、脑电双频指数改变以及麻醉药用量、麻醉后恢复情况.结果3组患者诱导后收缩压(SBP)、舒张压(DBP)明显降低(P＜0.05),PR组心率明显减慢(P＜0.05),PF,PR组气管插管、切皮后SBP及DBP无明显改变,P组则明显升高(P＜0.05).PR,PF组异丙酚麻醉维持用量分别较P组降低32.8%和24.0%(P＜0.05).结论瑞芬太尼、芬太尼能明显减少异丙酚用量,抑制气管插管及切皮时的反应,以瑞芬太尼作用明显.
Objective To evaluate the influence of remifentanil and fentanyl on anesthetic effect of propofol in total intravenous anesthesia(TIVA). Methods One hundred and ten patients scheduled for elective surgery were randomly divided into propofol group(group P, n=30),propofol-fentanyl group(group PF, n=52) and propofol-remifentanil group(group PR, n=28). The hemodynamic changes and recovery of anesthesia were observed in all patients. The patients were anesthetized with target controlled infusion of propofol and fentanyl(2 μg/L) or continuous infusion remifentanil 0.25～0.5,0.125～0.25 μg/(kg·min) . The initial target plasma concentration of propofol was 1 mg/L and increased gradually until loss of consciousness. Results Blood pressure was significantly lowered in all groups, and HR decreased in PR group after induction of anesthesia(P<0.05). Systolic and diastolic blood pressure increased significantly after intubation and skin incision in group P. The dosage of propofol required for maintenance of anesthesia in group PF and group PR were reduced by 24.0% and 32.8% respectively. Conclusions Remifentanil and fentanyl can significantly reduce the dosage of propofol for loss of conciousness and inhibit the hemodynamic responses to tracheal intubation and skin incision.
Guangdong Medical Journal
Propofol Remifentanil Fentanyl Total intravenous anesthesia Target controlled infusion