瑞芬太尼复合异丙酚在鼾症手术患者评价.docVIP

瑞芬太尼复合异丙酚在鼾症手术患者评价 　［摘要］ 目的 比较瑞芬太尼、异丙酚全凭静脉与异丙酚、异氟醚静吸复合麻醉对阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS，即鼾症）患者血流动力学的影响及苏醒期的特点。方法 选择择期行悬雍垂-腭-咽成形术(uvulopalatopharyngoplasty，UPPP)的OSAS患者42例，随机分为全凭静脉麻醉（TIVA）与静吸复合麻醉（C）两组。TIVA 组（n=20例）诱导采用瑞芬太尼1 μg/kg，异丙酚2.5 mg/kg及琥珀胆碱1.5 mg/kg后经鼻插管，维持采用瑞芬太尼0.2 μg/（kg·min）+异丙酚4～6 mg/（kg·h）全凭静脉麻醉，在手术结束前15 min停止瑞芬太尼，追加氯诺昔康8 mg。C 组（n=22例）诱导采用芬太尼2 μg/kg，异丙酚2.5 mg/kg及琥珀胆碱1.5 mg/kg后经鼻插管，维持采用异丙酚4～6 mg/（kg·h）+异氟醚（维持呼出浓度在0.8～1.2 MAC）静吸复合麻醉，手术结束前30 min关闭异氟醚吸入，改用异丙酚6～8 mg/(kg·h)输注，切皮前5 min及术中追加芬太尼。记录诱导前、诱导后、插管后、切皮后、切皮后20 min、切皮后60 min、拔管后、拔管后20 min、拔管后60 min的MAP、HR；两组手术时间、手术结束至拔管的时间、术中肌松药总量及术后躁动、恶心呕吐、疼痛等不良反应，并比较两组患者的麻醉费用。结果 TIVA组病人在术中血流动力学方面比C组病人平稳，拔管时间较C组短，且术后躁动、恶心呕吐较C组发生率低（Plt;0.05）；TIVA组与C组病人在术后疼痛评分差异无显著性，但TIVA组麻醉费用较C组高。结论 瑞芬太尼复合异丙酚全凭静脉麻醉用于鼾症患者有较明显的临床使用价值。 ［关键词］ 瑞芬太尼;异丙酚;全凭静脉麻醉;静吸复合麻醉;悬雍垂-腭-咽成形术 Evaluation of remifentanil combined with propofol in UPPP surgery ［Abstract］ Objective The purpose of this study is to evaluate the clinical efficacy of remifentanil combined with propofol in uvulopalatopharyngoplasty (UPPP) surgery.Methods Forty two ASA I～II patients undergoing UPPP surgery were randomly divided into two groups： TIVA group (remifentanil-propofol，n=20) and C group (remifentanil-isoflurane，n=22).Patients in TIVA group were induced with remifentanil 1μg/kg，propofol 2.5mg/kg and scoline 1.5mg/kg and maintained with remifentanil 0.2μg/(kg·min) and propofol 4～6mg/(kg·h) intravenously，while those in C group were induced with fentanil 2μg/kg，propofol 2.5mg/kg and scoline 1.5mg/kg and maintained with remifentanil 0.2μg/(kg·min) and exhaling isoflurane (0.8～1.2%).Results The hemodynamics of patients of different time points were more stable in TIVA group.The time of extubation was shorter and the level of wakeness was much better in TIVA group，but the cost was also higher in TIVA group than in C group.Conclusion The anesthesia method of TIVA combined with remifentanil and propofol is an ideal method in OSAS　undergoing UPPP surgery. ［K