瑞芬太尼在腹腔镜手术麻醉中应用观察分析.docVIP

瑞芬太尼在腹腔镜手术麻醉中应用观察分析 　【摘要】 目的 观察分析瑞芬太尼在腹腔镜手术麻醉中应用的有效性和安全性。方法 42例择期行腹腔镜胆囊切除术的病人，随机分为R组21例（瑞芬太尼组）和F组21例（芬太尼组）。麻醉诱导采用静脉注射异丙酚、维库溴铵、咪唑安定以及瑞芬太尼或芬太尼。麻醉维持采用吸入异氟醚及持续静脉泵注瑞芬太尼或芬太尼。观察诱导前、诱导后1min、气管插管后5min内及术后5min的血流动力学变化，同时观察麻醉深度、麻醉苏醒及不良反应等情况。结果 两组诱导后MAP和HR值均较诱导前下降（Plt;0.05）。气管插管5min内R组血流动力学变化幅度明显小于F组（Plt;0.05），R组的呼之睁眼和拔管时间小于F组（Plt;0.05），术后苏醒恢复状况也优于F组。结论 使用瑞芬太尼麻醉的腹腔镜手术病人，其血流动力学更稳定，术后苏醒恢复快，麻醉效果好、安全。 【关键词】 瑞芬太尼 芬太尼 腹腔镜手术 Application of remifentanil for anaesthesia of laparoscopic surgery 【Abstract】 Objective To research the safety and availability of remifentanil for the anaesthesia of laparoscopic surgery.Methods 42 patients who would perform cholecystectomy were randomly and equally divided into R （remifentanil） and F （fentanil） groups. Anaesthesia induced by injecting propofol,vecuronium bromide, midazolam, reminfentanil or fentanil through the vein. Anaesthesia maintained by inhaling isoflurane and keeping on injecting remifentanil or fentanil through vein by the pump. The changes of bloodstream dynamics, anaesthesia depth, analepsia and adverse effect before and 1 min after inducing, 5 mins after windpipe intubation and 5 mins after operation were observed.Results MAP and HR decreased after inducing in both groups （Plt;0.05）. Within 5 mins of windpipe intubation, the change of bloodstream dynamics in F group was more obviously than that in R group （Plt;0.05）. The time of analepsia and pulling pipe in R group was shorter than those in F group （Plt;0.05）.Conclusion Application of remifentanil for anaesthesia of laparoscopic surgery can steady bloodstream dynamics and promote analepsia, which has better effect and safety. 【Key words】 Remifentanil; fentanil; laparoscopic surgery 瑞芬太尼（reminfentanil）是一种新型的μ受体激动剂，其半衰期极短。具有起效迅速、镇痛作用强、恢复迅速、无蓄积、后遗症少、呈剂量依赖性降低血压和心率，能有效抑制气管插管和手术应激时的高血压反应，术后病人苏醒快，拔管时间早，定向能力恢复快，神经认知测试明显优于传统的阿片类药。本文旨在观察分析瑞芬太尼用于腹腔镜手术（LC）麻醉的安全性和有效性，以利于更好地应用于临床。 1 资料与方法 1．1 临床资料 ASAⅠ～Ⅱ级择期行LC的病人42例，男7例，女35例，年龄16～62岁。术前未长期服用阿类片药物，无肝、肾功能障碍。随机分为瑞芬太尼（R）组和芬太尼（F）组，每组各21例。 1．2