瑞芬太尼用于鼻内窥镜手术麻醉临床研究.docVIP

瑞芬太尼用于鼻内窥镜手术麻醉临床研究 应俊， 朱晓红，卢忆梅，陈受琳 江西医学院第二附属医院麻醉科，江西　南昌市330006 摘要：目的：比较瑞芬太尼和芬太尼用于鼻内窥镜手术麻醉的安全性和有效性.方法：40例行鼻内窥镜手术患者随机分为瑞芬太尼组和芬太尼组，每组20例。麻醉诱导采用静脉注射丙泊酚（2mg/kg）和瑞芬太尼(2ug/kg)或芬太尼（2ug/kg）。麻醉维持采用持续静脉泵注异丙酚(6mg/kg)，以及持续泵注瑞芬太尼0.2ug/kg.min或芬太尼0.02ug/kg.min。观察术中血压、心率、麻醉深度、阿托品、麻黄素、乌拉地尔的使用量，麻醉苏醒及不良反应等情况。结果：两组诱导后收缩压（SBP）、舒张压（DBP）明显降低（P＜0.05），瑞芬太尼组心率明显减慢（P＜0.05）。麻醉维持期间，瑞芬太尼组患者血流动力学变化幅度显著小于芬太尼组（P＜0.05）。瑞芬太尼组清醒时间，拔管时间短于芬太尼组。结论：瑞芬太尼镇痛作用强于芬太尼，停止输注后其作用消退快于芬太尼。 关键词: 瑞芬太尼; 芬太尼; 鼻内窥镜手术; 麻醉,全身 To Study the Efection of Remifentanil Used For ESS YING Jun, ZHU Xiao-hong, LU Yi-mei, CHENG Shou-ling (.Department of Anesthesiolgy, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang 330006,China) Abstract Objective: To compare the efficary and safely of remifentanil with fentanyl used for ESS. Methods: 40 patients undergoing ESS were randomly assigned to remifentanil group or fentanyl group with 20 cases in each group. Anesthesia was induced with propofol(2mg/Kg) and either remifentanil (2μg/Kg) or fentanly (2μg/Kg), and was maintained with a continuous infusion of propofol (6mg/kg?min) and a continuous infusion of either remifentanil (0.2μg/kg?min) or fentanly (0.02μg/kg?min). Blood pressure (BP), heart rate (HR), depth of anesthesia, the dose of ephedrine, atropine, urapidil required during surgery, recovery profile of anesthesia and adverse reactions were observed. Results: Blood pressure was significantly lowered in two groups, and HR decreased in PR group (P＜0.05). Extubation time and emergence time in the remifentanil group were shorter than in the fentanyl group. Conclusion: The analgesic effects of remifentanil are more potent than those of fentanyl, and remifentanil wore off fasten incomparable doses. Keyword: Remifentanil; Fentanyl; ESS; Anesthesia,general 瑞芬太尼是一种新型短效u阿片类受体激动剂，具有独特的药代学特性[1]。它起效快（血液和效应室平衡半衰期为1.3min），时效半衰期短，可控性好，是静脉麻醉的理想药物。本文旨在观察瑞芬太尼用于鼻内窥镜手术有效性及安全性，为临床提供参考。 1资料与方法 1.1　一般资料：　选择临床分型分期为II型2期[2]的慢性鼻窦炎鼻息肉病人40例，年龄16－70岁，ASAI～II级，全部病人术前无肝、肾、心、肺功能不全，无高血压，排除15天内服用单胺