【摘要】 目的 確定在不同濃度七氟醚復合瑞芬太尼誘導無肌松氣管插管時瑞芬太尼的半數有效量（ED50）。 方法 2009年7月-2009年11月擇期手術患者60例，ASA I~II，年齡20~59歲，按照入室的順序隨機分為Ⅰ組（2%七氟醚組）和Ⅱ組（3%七氟醚組），預沖8%七氟醚誘導，眼瞼反射消失后，調節七氟醚呼氣末濃度分別維持在2%或3%，同時按照序貫法注入瑞芬太尼，瑞芬太尼注射90 s后氣管插管。記錄麻醉誘導前、患者意識消失時、插管前1 min、插管后1 min及插管后3 min心率、平均動脈壓的變化。 結果 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量（ED50）及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。 結論 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。【Abstract】 Objective To determine the half effective dose (ED50) of remifentanil dose for tracheal intubation without neuromuscular relaxant in adult when combined with different concentration of sevoflurane. Methods Sixty ASA Ⅰ to Ⅱ adult aged 20 to 59 years old, scheduled for elective surgery under general anesthesia were enrolled in this study between July 2009 to November 2009. All patients were ranged randomly into Group Ⅰ (2% sevoflurane) and Group Ⅱ (3% sevoflurane).Anesthesia was induced with 8% sevoflurane in 100% oxygenat at 6 L/min.After the loss of eyelash reflex, remifentanil was injected over 30 s, end-tidal sevoflurane concentration 2% or 3% was maitained. The dose of remifentanil was determined by up-and-down method. In 90 s after the end of bolus administration of remifentanil, the trachea was intubated. Mean blood pressure and heart rate were recorded at anaesthetic induction, the loss of eyelash reflex, before, in 1 min and 3 min after intubation. Results ED50 values (95% confidence intervals)of remifentanil for tracheal intubation during 2% and 3% sevoflurane induction without neuromuscular relaxant were 0.585 μg/kg and 0.533 - 0.626 μg/kg, and 0.492 μg/kg and 0.451 - 0.572 μg/kg, respectively. Conclusion ED50 values (95% confidence intervals)of remifentanil for tracheal intubation 2% and 3% sevoflurane induction without neuromuscular relaxant are 0.585 μg/kg (0.533 - 0.626 μg/kg) and 0.492 μg/kg (0.451 - 0.572 μg/kg), respectively.
目的:探討甲狀腺手術中氟比洛芬酯對丙泊酚—瑞芬太尼麻醉效果的影響。方法:將210例擇期丙泊酚—瑞芬太尼麻醉下行甲狀腺手術患者隨機分為對照組和氟比洛芬酯組,每組105例。于切皮前30 min,對照組靜脈注入等量生理鹽水10mL,氟比洛芬酯組經靜脈注入氟比洛芬酯注射液100 mg。分別記錄患者麻醉前10 min (T0)、切皮時(T1)、切皮后10 min (T2)、切除腺體時 (T3)以及拔管時 (T4) 的血流動力學 (SBP、DBP、HR) 的變化以及術后口述描述評分(VRS)。結果:與對照組比較, 氟比洛芬酯組T14時SP、DP均降低,兩組差別有統計學意義(Plt;005)。氟比洛芬酯組離開手術室時無痛率明顯高于對照組,兩組差別有統計學意義(Plt;005)。結論:氟比洛芬酯對丙泊酚—瑞芬太尼麻醉下行甲狀腺手術患者血流動力學影響小,且減輕術后疼痛,術后恢復更為舒適。
目的:比較七氟醚吸入麻醉和丙泊酚、瑞芬太尼靜脈麻醉用于小兒手術的臨床效果。方法:100例1～8歲的患兒隨機分為丙泊酚、瑞芬太尼組(A組)與七氟醚吸入組(B組）。麻醉誘導后,A組持續輸注丙泊酚和瑞芬太尼維持麻醉,B組吸入七氟醚維持麻醉。術中根據生命體征調整丙泊酚、瑞芬太尼的輸注速度及七氟醚的吸入濃度,記錄術中循環變化、術后麻醉恢復情況。結果:與B組相比,A組術中MAP下降明顯(Plt;005)。結論:與A組相比,B組術中生命體征控制平穩;術后清醒迅速、完全、平穩,拔管時間無明顯差異。
目的:比較瑞芬太尼聯合異丙酚或依托咪酯全麻在腹腔鏡婦科手術中的臨床效果。方法:擇期腹腔鏡婦科手術80例,隨機分成瑞芬太尼異丙酚組(RP組)和瑞芬太尼依托咪酯組(RE組),各40例。兩組全麻誘導用藥相同,維持麻醉RP組采用瑞芬太尼聯合異丙酚、RE組采用瑞芬太尼聯合依托咪酯。記錄基礎值、誘導后、插管后1 min、3 min、氣腹時、氣腹后10、20、30、40 min的動脈收縮壓(SBP)、舒張壓(DBP)、心率(HR);記錄停藥至自主呼吸恢復、睜眼、拔除氣管導管、恢復定向能力的時間;記錄清醒即刻及清醒后1、2、4、8、12、16、20、24 h患者疼痛程度,采用VAS評分;記錄24 h內不良反應發生情況。 結果: 兩組SBP、DBP均在誘導后明顯低于基礎值(Plt;001), 插管后恢復,氣腹開始后趨于平穩;兩組HR均在誘導后減慢(Plt;001),插管后及氣腹開始時恢復。RP組自主呼吸恢復、呼之能睜眼、拔除氣管導管及恢復定向能力的時間均明顯短于RE組(Plt;001)。麻醉清醒即刻、清醒后1、2、4、8 h VAS評分RE組明顯低于RP組(Plt;005),12、16、20、24 h VAS評分兩組比較無顯著性差異(Pgt;005)。術后發生惡心嘔吐患者數RP組明顯減少(Plt;005)。 結論:全麻行腹腔鏡婦科手術時,瑞芬太尼聯合異丙酚或依托咪酯都能緩解氣腹及手術引起的血流動力學變化,瑞芬太尼聯合異丙酚術后蘇醒快且能明顯降低術后惡心嘔吐的發生率,但術后疼痛較為嚴重。
目的 系統評價瑞芬太尼用于全身麻醉下剖宮產時對新生兒的影響。 方法 檢索Cochrane Library、PubMed、OVID、EMbase、CNKI、萬方等中外數據庫，收集1990年－2012年關于瑞芬太尼用于全身麻醉下剖宮產的臨床隨機對照研究。按Cochrane系統評價方法評估文獻質量，用Revman 5.1軟件對提取的數據進行Meta分析。 結果 共納入10項研究，包括342例產婦。與空白對照組相比，瑞芬太尼降低新生兒1 min Apgar評分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生時臍動脈pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生時窒息發生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；當誘導劑量為1.0～1.5 μg/kg時，對5 min Apgar評分無影響[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。 結論 瑞芬太尼用于全身麻醉剖宮產可減輕新生兒酸中毒，但是會對新生兒產生一過性的呼吸抑制。
目的:觀察舒芬太尼復合異丙酚自控鎮靜鎮痛在結腸鏡檢查中的效果及不良反應,從而探討該方法的安全性和有效性。方法:行無痛纖維結腸鏡檢查的患者60例,隨機分為兩組:自控鎮痛/鎮靜組和靜脈復合全麻醉組,每組30例。自控鎮痛/鎮靜組首先緩慢靜脈注射舒芬太尼0.12 μg/kg,隨之接電子自控鎮痛泵,負荷量設定為0.5 mg/kg,以4 mg/kg·h的速度持續泵入異丙酚(10 mg/mL),術中按壓1次自控手柄可快速推注異丙酚1 mL。靜脈復合全麻醉組首先靜脈緩慢推注芬太尼1 μg/kg,咪唑安定0.02 mg/kg, 2 min后緩慢推注異丙酚0.8～1 mg/kg。術中間斷給予異丙酚以維持聽覺誘發電位指數(AAI)于30～40之間。結果:靜脈復合全麻醉組的MAP較檢查前明顯下降且較自控鎮痛/鎮靜組下降更為明顯且具有統計學意義(Plt;0.05)。自控鎮痛/鎮靜組的呼吸頻率較靜脈復合全麻醉組下降明顯且在T3時間點具有統計學意義(Plt;0.05)。自控鎮痛/鎮靜組患者OAA/S評分達5分和Aldrete評分達9分的時間均較靜脈復合全麻醉組明顯縮短(1.4±1.3 VS 3.9±1.7和 2.9±1.7 VS 5.7±1.7)(Plt;0.05)。兩組的內鏡醫師和患者滿意度評分無統計學差異(P＞0.05)。結論:自控鎮靜鎮痛能夠比傳統的靜脈全身麻醉提供更良好的循環系統穩定性,更迅速的麻醉后恢復,是結腸鏡檢查鎮靜鎮痛的理想和安全方法。
Objective To assess the safety and efficacy of sufentanil combined with propofol for painless fiberbronchoscopy. Methods A total of 120 patients undergoing fiberbronchoscopy were divided into two groups according to their admission sequence: group S (sufentanil + propofol, n=60) and group F (fentanil + propofol, n=60). Parameters including heart rate (HR), systol ic blood pressure (SBP), diastol ic blood pressure (DBP), saturation of blood oxygen (SPO2), dose of propofol, duration of the procedure, waking time and score of Observer’s Assessment of Alertness/Sedation (OAA/S) scale were recorded. Results The HR increased significantly 3 minutes after drug administration in both groups (Plt;0.05). The SPO2 decreased significantly 3 minutes after drug administration in both groups (Plt;0.05). The average dose of propofol and OAA/a score were similar between the two groups (Pgt;0.05). The waking time was significantly shorter in group S than in group F (Plt;0.05). Conclusion Sufentanil combined with propofol could offer a good sedative/analgesic effect during painless fiberbronchoscopy.
【摘要】 目的 比較術后芬太尼皮下鎮痛（PCSA）與硬膜外鎮痛（PCEA）的臨床效果，以及對胃腸功能的影響。 方法 2009年1-6月間觀察擇期硬膜外麻醉下經腹子宮切除術患者120例，術后分別實施PCSA與PCEA，觀察術后第4、8、12、24、48 h的鎮痛、鎮靜情況，呼吸循環、惡心嘔吐及其他不良事件，記錄術后首次肛門排氣時間，測評術后鎮痛滿意度。 結果 術后兩組患者鎮痛優良率均在90%以上，各時點鎮痛評分、鎮靜評分、惡心嘔吐發生率、首次肛門排氣時間以及患者鎮痛優良率差異均無統計學意義（Pgt;0.05）。 結論 術后芬太尼PCSA與PCEA一樣，效果確切，對術后胃腸功能無明顯影響，患者滿意，是一種安全、有效的鎮痛方法。【Abstract】 Objective To compare clinical efficiency and gastrointestinal reaction of subcutaneous patient-controlled analgesia (PCSA) and epidural patient-controlled analgesia (PCEA) with fentanyl analgesic for patients after operation. Methods A total of 120 patients having undergone transabdominal hysterectomy under epidural anesthesia between January and June 2009 accepted PCSA or PCEA after operation. We evaluated the state of analgesia and sedation at the 4th, 8th, 12th, 24th and 48th hour after operation. We also looked into the respiration, blood circulation, nausea, vomiting and other abnormal events of the patients during the first 48 hours after operation. At the same time, we recorded the first time of anal exsufflation after operation and the degree of patients’ satisfaction. Results The analgesic effective rate was higher than 90% in both groups. There were no significant differences in analgesia and sedation scores at above-mentioned points after operation, incidence of nausea and vomiting, first time of anal exsufflation or analgesic effective rate between the two groups. Conclusion PCSA with fentanyl can be as effective in relieving postoperative pain as PCEA with fentanyl without obvious adverse effect in the gastrointestinal function. Therefore, PCSA is a safe and effective method to alleviate postoperative pain.