丙泊酚瑞芬太尼靶控全静脉麻醉用于眶内手术.docVIP

丙泊酚瑞芬太尼靶控全静脉麻醉用于眶内手术 　【摘要】 目的 观察丙泊酚、瑞芬太尼靶控输注（TCI）全静脉麻醉用于眼眶手术的可行性与安全性。方法 择期眶内手术成年患者76例，ASAⅠ～Ⅱ级，随机分为A、B两组各38例。A组以丙泊酚、瑞芬太尼TCI静脉诱导，插管后全程TCI维持麻醉；B组常规诱导插管后，吸入七氟烷＋N2O维持。无创心功能血流动力学监测系统全程监测，记录诱导前，气管插管即刻，插管后1、3、5 min、切皮、拔管即刻、拔管后1、5 min循环动力学变化，停止输注至气管导管拔除时间，麻醉、手术中不良事件及处理。结果 两组患者术前一般情况差异无统计学意义，麻醉诱导及维持期间血流动力学均较平稳。A组拔管时间（10.6±2.03）min短于B组（17.14±2.84）min，P=0.031。术后恶心、呕吐（0 vs.5，P=0.021）；躁动（0 vs.4,P=0.04）低于B组（Plt;0.05）。结论 丙泊酚、瑞芬太尼TCI用于眶内手术麻醉，能有效预防麻醉诱导刺激和手术操作应激反应，循环波动小；术野稳定，便于手术操作；术后清醒迅速，彻底，不良反应少，辅以适当术后镇痛，能满足眶内手术需求。 【关键词】 丙泊酚；瑞芬太尼；靶控输注 ［Abstract］ Objective To investigate the feasibility and safety of target controlled infusion （TCI） with propofol and remifentanil in total intravenous anesthesia for ophthalmic orbital surgery.Methods Propofol and remifentanil TCI was used for induction and maintenance in group A（experimental group）. Anesthesia maintenance was with inhaled sevoflurane combined with nitrous oxide in group B （control group） following conventional practice intravenously.Esmerone was injected intermittently intravenously to keep muscles relaxing during the operation in both groups. Non-invasive haemodynamics was monitorred during whole stage and changes of circulating parameters were recorded pre-induction, right tracheal intubation and 1,3,5 minutes post-intubation, at incision, right extubation and 1,5 minutes post-extubation, stop of TCI to extubation and adverse events and therapies during the operation were record.Flurbiprofen was used for post-operation pain relief.Results There were no statistical significances in patients’ ASA general status and age, gender, weight, height between two groups.Haemodynamics of both groups was stable during the procedures.Awake time was much shorter in group A than that of in group B［（10.6±2.03）min vs.（17.14±2.84）min，P=0.031］.Postoperative nausea and vomiting and restlessness were much higher in group A than that of in group B（PONV, 0 vs.5,P=0.021;restlessness 0 vs.4,P=0.04）.Conclusion Propofol plus remifentanil TCI can effectively