瑞芬太尼芬太尼及瑞芬太尼復(fù)合全麻的對(duì)照研究

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1、瑞芬太尼芬太尼及瑞芬太尼復(fù)合全麻的對(duì)照研究作者：周清河肖旺頻姚明安爾丹杜炎芳【摘要】目的對(duì)比研究瑞芬太尼、芬太尼復(fù)合瑞芬太尼在全麻術(shù)中應(yīng)用的可行性和有效性。方法ASAⅠ～Ⅱ級(jí)腹部胃腸道手術(shù)患者60例隨機(jī)分為三組:F、R組和RF組,每組20例。F組血漿靶控芬太尼術(shù)中鎮(zhèn)痛，芬太尼血漿靶濃度根據(jù)手術(shù)刺激調(diào)整，手術(shù)結(jié)束前半小時(shí)停止；R組用瑞芬太尼替代芬太尼；RF組瑞芬太尼復(fù)合芬太尼，胃腸道吻合操作完成前主要由芬太尼維持鎮(zhèn)痛，其后主要由瑞芬太尼維持鎮(zhèn)痛。結(jié)果R組誘導(dǎo)時(shí)發(fā)生嗆咳、肌肉強(qiáng)直、心動(dòng)過緩均比其余兩組多。R

2、組蘇醒期MAP和HR與其余兩組相比明顯增高（P<0.05）。蘇醒期R組發(fā)生躁動(dòng)、高血壓、心動(dòng)過速均比其余兩組增多明顯。與F組相比，R和RF組拔管時(shí)間、出恢復(fù)室時(shí)間明顯縮短（P<0.05）。RF組瑞芬太尼用量與R組相比明顯減少（P<0.05），RF組芬太尼用量與F組相比明顯減少（P<0.05）。R、RF組的拔管后即刻、離開PACU、拔管后1hOAA/S評(píng)分明顯比F組高（P<0.05）。RF組患者拔管后即刻、離開PACU時(shí)疼痛評(píng)分與R組相比，差異顯著（P<0.05）。結(jié)論

3、三種麻醉方法術(shù)中均能提供良好的鎮(zhèn)痛，滿足手術(shù)要求。但瑞芬太尼聯(lián)合芬太尼既能提供完善的鎮(zhèn)痛，維持術(shù)中血流動(dòng)力學(xué)平穩(wěn)，術(shù)畢又能蘇醒迅速且蘇醒質(zhì)量高。9【關(guān)鍵詞】芬太尼瑞芬太尼全身麻醉靶控輸注　　【Abstract】ObjectiveTomakeacomparativestudyonthefeasibilityandvalidityofusingremifentanil、fentanylandremifentanilingeneralanaesthesia.Methods60ASAclassⅠ～Ⅱpatien

4、tsundergoingabdomenoperationswererandomlydividedintothreegroups：groupF、groupRandgroupRFwith20casesineachgroup.IngroupF,analgesiawasinducedandmaintainedwithTCIfentanyl.Thetargetplasmaconcentrationoffentanylwasadjustedbasedonoperationstimulationandstoppeta

5、t30minbeforetheendofsurgery.InGroupR,fentanylwasreplacedbyremifentanil.InGroupRF,analgesiawasinducedandmaintainedwithTCIremifentanil-fentanyl,analgesiawasmaintainedwithfentanylbeforegastrointestinaltractanastomosisandwithremifentanilafterwards.ResultsThe

6、occurrenceofcough、muscletwitch、bradycardiaingroupRweremorethanothertwogroupsduringinducement.MAPandHRingroupRweresignificantlyhigherthanothertwogroupsduringrecoveryfromanesthesia（P<0.05）.Theoccurrenceoffidget、hypertension、tachycardiaweremorethanothert

7、wogroupsduringrecoveryfromanesthesia（P<0.05）.Thedurationfromterminationof9anesthesiatotracheaextubationandthestayinPACUwassignificantlyshorteringroupRandgroupRFthaningroupF（P<0.05）.ThequantityofremifentanilusedingroupRFwassignificantlylowerthaningr

8、oupRandthequantityoffentanylusedingroupRFwassignificantlylowerthaningroupF（P<0.05）.TheOAA/SscoresweresignificantlygreateringroupRandgroupRFthaningroupFatthetimepointoftracheaextubation、leavingPACUand1haftertracheaextuba