摘要
目的研究瑞芬太尼静脉麻醉在妇科电视腹腔镜手术中是否较芬太尼更具优势。方法80例美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级、电视腹腔镜下行卵巢囊肿剥出术的患者随机均分为两组。瑞芬太尼组以丙泊酚2mg／kg、瑞芬太尼2μg／kg、维库溴铵0．1mg／kg诱导，术中以丙泊酚6mg·kg-^1·h^-1、瑞芬太尼0．2μg·kg^-1·min^-1维持麻醉；芬太尼组以丙泊酚2mg／kg、芬太尼2．5μg／kg、维库溴铵0．1mg／kg诱导，术中以丙泊酚6mg·kg^-1·h^-1维持麻醉，手术开始时追加芬太尼2．5μg／kg（总量为5μg／kg）；两组均按需追加维库溴铵。比较两组间术中血流动力学变化、术后自主睁眼时间和拔管时间、术后1h内需追加阿片类止痛药物的情况及不良反应发生率。结果与芬太尼组比较，瑞芬太尼组术中高血压的发生率较低（P〈0．05），而窦性心动过缓（心率〈60次／min）的发生率较高（P〈0．01），但两组间需要处理的心动过缓（心率〈50次／min）发生率的差异无显著性（P〉0．05）。两组间术后主动睁眼时间和拔管时间、术后1h内需追加阿片类药物止痛的病例数及不良反应发生率的差异均无显著性（P值均〉0．05）。结论瑞芬太尼用于妇科电视腹腔镜手术较芬太尼有更稳定的血流动力学，且术后并不增加对止痛药的需求。
Objective To investigate the advantages of remifentanil vs fentanyl in gynecological laparoscopic operations. Methods Eighty patients （ASA Ⅰ～Ⅱ, 18-45 years old） undergoing selective simple ovary-cystectomy via laparoscopy were randomly divided into 2 groups（n：40）. Group R： induced with propofol 2 mg/kg, remifentanil 2μg/kg and vecuronium 0.1 mg/kg, maintained with propofol 6mg·kg-^1·h^-1, remifentanil 0.2μg·kg-^1·h^-1 .Group F： induced with propofol 2 mg/kg, fentanyl 2.5μg/kg and vecuronium 0. 1 mg/kg, maintained with propofol 6 mg·kg-^1·h^-1, and added fentanyl 2.5 μg/kg at the beginning of the operations （total dose 5μg/kg）. All patients added vecuronium if needed. Results There were no differences in conscious state with eye opening, in the extubation time, opioids for pain control and adverse effects after operations. Remifentanil had better hemodynamic effects, i.e. the patients in group R had much less hypertensive episode during the operations （P〈0.05） and had more bradyeardia cases （P〈0.01）. But there was no difference between the episodes of the bradycardia needing adjustment （HR〈50 beats/min） in the two groups. Conclusions Remifentanil has better hemodynamic effects than fentanyl in anesthesia of Television laparoscoplc operations and no need of more opioids for postoperative analgesia. （Shanghai Med J, 2006, 29：89 91）
出处
《上海医学》
CAS
CSCD
北大核心
2006年第2期89-91,共3页
Shanghai Medical Journal
