摘要
目的 评价瑞芬太尼复合异氟醚吸入麻醉对脊柱侧凸矫形术患者术中唤醒试验的影响。方法 40例全麻下行脊柱侧凸矫形术患者，ASAⅠ或Ⅱ级，年龄8～20岁，随机分为2组：芬太尼组（F组）和瑞芬太尼组（R组），每组20例。低流量吸入异氟醚（新鲜气流量为1L／min，N2O：O2=1：1）维持麻醉。F组间断静脉注射芬太尼1—1．5μg／kg维持镇痛；R组静脉输注瑞芬太尼0．2／μg·kg^-1·min^-1维持镇痛，唤醒试验开始时调至0．05／Lg·kg^-1·min^-1，唤醒试验后恢复原速度至手术结束。于相应时点记录唤醒时间、呼气末异氟醚浓度（ETiso）以及平均动脉压（MAP）、心率（HR），唤醒试验中呛咳，躁动、术后恢复时间、术后恶心呕吐（PONV）发生情况及PCA吗啡用量。结果 R组较F组唤醒时间缩短，唤醒试验前HR及ETiso降低（P〈0．05），术后吗啡用量增加（P〈0．01），两组患者PONV发生情况差异无统计学意义，未见术中知晓发生。结论 静脉输注瑞芬太尼复合吸入异氟醚麻醉可缩短术中唤醒时间；与芬太尼相比，更适用于脊柱侧凸矫形术患者。
Objective To evaluate the effects of combined remifentanil-isoflurane anesthesia on intraoperative wake-up test and recovery profile in scoliosis surgery. Methods Forty ASA Ⅰ or Ⅱ patients aged 8- 20 yr undergoing scoliosis surgery were randomly divided into 2 groups （ n = 20 each） ： fentanyl group （F） and remifentanil group （R）. Anesthesia was maintained with low-flow （ 1 L/min ） inhalation of isoflurane and nitrous oxide in oxygen （ N2O ：O2 = 1 ： 1 ） and intermittent i.v. boluses of fentanyl （ 1.0-1.5 μg/kg every 30 min） or continuous infusion of remifentanil （0.2 μg· kg^-1 · min^-1 ）. In group R the infusion of remifentanil was reduced to 0.05 μg·kg ^-1· min^-1 immediately before wake-up test and returned after wake-up test to the previous rate （0.2 μg · kg^-1·min^-1） which was maintained until the end of surgery. The wake-up test time, postoperative recovery time, end-tidal isoflurane concentration and bemodynamic variables including MAP and HR were recorded. Bucking and/or restlessness during the wake-up test, postoperative nausea and vomiting （PONV） and the amount of morphine consumed in patient-controlled analgesia （PCA） were also recorded. Results The intraoperative wakeup time was significantly shorter, the HR and end-tidal isoflurane concentration were significantly lower and the amount of morphine consumed in PCA was significantly larger in group R than in group F （P 〈 0.05 or 0.01）. However no significant difference in the incidence of PONV was found between the two groups. No patient could recall the wake-up test or other events occurring during the surgery. Conclusion Continuous infusion of remifentanil combined with isoflurane inhalation can shorten the intraoperative wake-up time, and is an appropriate anesthetic technique for scoliosis surgery.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第2期103-106,共4页
Chinese Journal of Anesthesiology
