【摘要】 目的 比较瑞芬太尼、丙泊酚、艾司洛尔用于支撑喉镜手术气管插管时患者的心血管反应。 方法 选取2009年1-3月就诊的60例拟于全身麻醉下行择期支撑喉镜下声带息肉切除术的患者，随机分为丙泊酚组、艾司洛尔组和瑞芬太尼组，每组20例。麻醉诱导采用咪达唑仑、芬太尼和丙泊酚，患者意识消失后给予琥珀胆碱。1 min后各组分别给予丙泊酚2 mg/kg、艾司洛尔1 mg/kg和瑞芬太尼1 μg/kg。30 s后进行气管插管。记录患者诱导前及插管前、插管后1、3、5 min的心率和血压水平。 结果 各组插管前的收缩压和心率较诱导前明显降低，插管后1、3 min的收缩压和心率较插管前升高（Plt;0.05)。丙泊酚组和艾司洛尔组插管后的收缩压较瑞芬太尼组升高（Plt;0.05)。丙泊酚组插管后心率较瑞芬太尼组增加（Plt;0.05)。 结论 对行支撑喉镜手术的患者，气管插管前30 s给予1 μg/kg瑞芬太尼较2 mg/kg丙泊酚和1 mg/kg艾司洛尔能更有效地减轻气管插管时的血流动力学反应。【Abstract】 Objective To assess the different effects of remifentanil, propofol, and esmolol on hemodynamic responses during intubation in CO2 laser endolaryngeal microsurgery (CO2-LELM). Methods A total of 60 patients aged from 18 to 65 years, admitted from January to March 2009 and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group, an esmolol group, and a remifentanil group. Anesthesia was induced with midazolam (0.015-0.02 mg/kg), fentanyl (1 μg/kg), and propofol (1 mg/kg). After the patients became unconscious, succinylcholine (1 mg/kg) was given one minute later. Then the patients in the three groups received propofol (2 mg/kg), esmolol (1 mg/kg), and remifentanil (1 μg/kg), respectively. Intubation was performed 30 secconds later. Heart rate (HR) and systolic blood pressure (SBP) were measured noninvasively before general anesthesia induction (baseline, Tb), just before intubation(Ti), and one, three, and five minutes after intubation (T1, T3, T5). Results The demographic data including age, sex and body weight were comparable in the three groups. Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti (Plt;0.05). After intubation, SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group (Plt;0.05), and HR in the propofol group was significantly higher than that in the remifentanil group (Plt;0.05). Conclusion In patients with CO2-LELM, remifentanil (1 μg/kg) administrated 30 seconds before intubation is maximal effective compared with propofol (2 mg/kg) or esmolol (1 mg/kg) in attenuating the hemodynamic responses to oraltracheal intubation.
目的:比较七氟醚吸入麻醉和丙泊酚、瑞芬太尼静脉麻醉用于小儿手术的临床效果。方法:100例1～8岁的患儿随机分为丙泊酚、瑞芬太尼组(A组)与七氟醚吸入组(B组）。麻醉诱导后,A组持续输注丙泊酚和瑞芬太尼维持麻醉,B组吸入七氟醚维持麻醉。术中根据生命体征调整丙泊酚、瑞芬太尼的输注速度及七氟醚的吸入浓度,记录术中循环变化、术后麻醉恢复情况。结果:与B组相比,A组术中MAP下降明显(Plt;005)。结论:与A组相比,B组术中生命体征控制平稳;术后清醒迅速、完全、平稳,拔管时间无明显差异。
目的:探讨甲状腺手术中氟比洛芬酯对丙泊酚—瑞芬太尼麻醉效果的影响。方法:将210例择期丙泊酚—瑞芬太尼麻醉下行甲状腺手术患者随机分为对照组和氟比洛芬酯组,每组105例。于切皮前30 min,对照组静脉注入等量生理盐水10mL,氟比洛芬酯组经静脉注入氟比洛芬酯注射液100 mg。分别记录患者麻醉前10 min (T0)、切皮时(T1)、切皮后10 min (T2)、切除腺体时 (T3)以及拔管时 (T4) 的血流动力学 (SBP、DBP、HR) 的变化以及术后口述描述评分(VRS)。结果:与对照组比较, 氟比洛芬酯组T14时SP、DP均降低,两组差别有统计学意义(Plt;005)。氟比洛芬酯组离开手术室时无痛率明显高于对照组,两组差别有统计学意义(Plt;005)。结论:氟比洛芬酯对丙泊酚—瑞芬太尼麻醉下行甲状腺手术患者血流动力学影响小,且减轻术后疼痛,术后恢复更为舒适。
目的:比较瑞芬太尼联合异丙酚或依托咪酯全麻在腹腔镜妇科手术中的临床效果。方法:择期腹腔镜妇科手术80例,随机分成瑞芬太尼异丙酚组(RP组)和瑞芬太尼依托咪酯组(RE组),各40例。两组全麻诱导用药相同,维持麻醉RP组采用瑞芬太尼联合异丙酚、RE组采用瑞芬太尼联合依托咪酯。记录基础值、诱导后、插管后1 min、3 min、气腹时、气腹后10、20、30、40 min的动脉收缩压(SBP)、舒张压(DBP)、心率(HR);记录停药至自主呼吸恢复、睁眼、拔除气管导管、恢复定向能力的时间;记录清醒即刻及清醒后1、2、4、8、12、16、20、24 h患者疼痛程度,采用VAS评分;记录24 h内不良反应发生情况。 结果: 两组SBP、DBP均在诱导后明显低于基础值(Plt;001), 插管后恢复,气腹开始后趋于平稳;两组HR均在诱导后减慢(Plt;001),插管后及气腹开始时恢复。RP组自主呼吸恢复、呼之能睁眼、拔除气管导管及恢复定向能力的时间均明显短于RE组(Plt;001)。麻醉清醒即刻、清醒后1、2、4、8 h VAS评分RE组明显低于RP组(Plt;005),12、16、20、24 h VAS评分两组比较无显著性差异(Pgt;005)。术后发生恶心呕吐患者数RP组明显减少(Plt;005)。 结论:全麻行腹腔镜妇科手术时,瑞芬太尼联合异丙酚或依托咪酯都能缓解气腹及手术引起的血流动力学变化,瑞芬太尼联合异丙酚术后苏醒快且能明显降低术后恶心呕吐的发生率,但术后疼痛较为严重。
目的 探讨丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤的保护作用以及作用机制。 方法 2009年6月－2011年12月选择择期需阻断肝门的肝脏手术患者40例，随机分为丙泊酚-瑞芬太尼组（P组）和异氟醚组（I组），每组20例。在术前（T0）和肝门阻断开放后30 min（T1）、60 min（T2）、6 h（T3）、24 h（T4）、72 h（T5）分别抽取动脉血，测定天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）和肿瘤坏死因子α（TNF-α）的含量。 结果 两组AST、ALT、TNF-α较术前均有增高，差异有统计学意义（P＜0.05）；P组增高幅度明显低于I组，差异有统计学意义（P＜0.05）。 结论 丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤具有保护作用，抑制TNF-α的产生可能为其作用机制之一。
【摘要】 目的 观察在腹腔镜胆囊切除术中，氯胺酮超前镇痛对瑞芬太尼麻醉后急性疼痛的影响。 方法 2009年10月-2010年1月，将择期行腹腔镜胆囊切除术患者90例，随机分为对照组（C组）、氯胺酮超前镇痛组（K组）、氯胺酮术毕镇痛组（K1组），每组30例。所有患者均采用瑞芬太尼复合丙泊酚静脉麻醉，K组在切皮前静脉给予氯胺酮0.5 mg/kg，K1组在关腹前静脉给予氯胺酮0.5 mg/kg，C组不给予任何药物。记录术毕患者麻醉恢复情况，各时间点疼痛程度。 结果 K组、K1组躁动发生率均明显低于C组（Plt;0.05）；术后2、4、8、24 h，K组VAS评分及镇痛药使用率明显低于C组和K1组（Plt;0.05）。 结论 氯胺酮超前镇痛能明显降低瑞芬太尼术后疼痛，并且不增加并发症发生率。【Abstract】 Objective To evaluate the preemptive analgesia of ketamine on remifentanil induced acute postoperative pain after laparoscopic cholecystectomy. Methods Ninty patients scheduled for laparoscopic cholecystectomy between october 2009 to Jannary 2010 were randomly assigned to three groups (n=30). Group K was administrated with 0. 5 mg/kg ketamine intravenously before skin incision, and Group K1 were administrated with 0. 5 mg/kg ketamine intravenously before abdominal closure, while Group C received nothing. The recovery and the side effects were recorded, the VAS at two, four, eight and 24 hours after surgery, and the use of anodyne were recorded. Results The incidence of restlessness in Groups K and K1 was remarkably lower than that of Group C (Plt;0. 05). The analgesic effects two, four, eight and 24 hours after surgery were obviously better in group K than those of Group C and Group K1 (Plt;0. 05). Conclusion Ketamine can produce preemptive analgesia to relieve remifentanil-induced acute pain, and it would not increase incidence of side effects.
ObjectiveTo study the feasibility of using propofol and remifentanil for tracheal intubation in patients who are awake, and investigate the influence of tracheal intubation on such vital signs as blood pressure and heart rates. MethodsEighty ASA I-Ⅱ patients who underwent general anesthesia in our hospital between December 2012 and April 2013 were randomly divided into two groups. Patients in group A received fentanyl-propofol, while patients in group B received remifentanyl-propofol-lidocaine. There was no significant difference between the two groups in gender, age, and body weight (P>0.05). Conventional intubation induction method was used for group A:0.05-0.10 mg/kg midazolam, 4 μg/kg fentanyl, 1.0-1.5 mg/kg propofol, and 0.6-0.9 mg/kg atracurium were given and tracheal intubation was performed after muscle relaxation. Group B patients were treated with remifentanyl propofol-lidocaine compound liquid slow intravenous injection, and compound cricothyroid membrane puncture method before endotracheal intubation. We observed the two groups of patients for vital signs before and after induction, and choking cough reactions. ResultsPatients in both the two groups were all able to complete tracheal intubation. Circulation change and incidence of tachycardia in patients of group A were significantly higher than those in group B (P<0.05). The rates of bradycardia, hypoxemia, and choking cough response were low in both groups with no statistically significant difference (P>0.05). ConclusionRemifentanyl propofol-lidocaine compound liquid can be safely used for implementation of endotracheal intubation in patients who are awake, and the hemodynamic stability can be maintained.
目的:观察等效剂量瑞芬太尼和芬太尼诱导气管插管对小儿血流动力学的影响。方法:40例择期行全麻患儿随机分为瑞芬太尼组和芬太尼组,麻醉诱导使用咪唑安定0.15mg/kg、丙泊酚2.5mg/kg、芬太尼2.5μg/kg或瑞芬太尼2μg/kg和维库溴铵0.1mg/kg。分别于麻醉诱导前(T0)、诱导后2min(T1)、插管后1、2min(T2、T3)记录心率、收缩压和舒张压。结果:两组诱导前血流动力学指标相似。与T0时比较,两组患儿T1时收缩压、舒张压均降低(Plt;0.05或Plt;0.01),心率均减慢(Plt;0.05或Plt;0.01);瑞芬太尼组T2.T3时收缩压、舒张压降低(Plt;0.05或Plt;0.01),心率减慢(Plt;0.05);芬太尼组T2、T3时收缩压、舒张压升高(Plt;0.05),心率增快(Plt;0.05)。与芬太尼组比较,瑞芬太尼组T1、T2和T3时收缩压、舒张压均降低(Plt;0.05),心率减慢(Plt;0.05)。结论:瑞芬太尼比等效剂量芬太尼能更好地抑制小儿全麻诱导气管插管时的心血管反应。
【摘要】 目的 确定在不同浓度七氟醚复合瑞芬太尼诱导无肌松气管插管时瑞芬太尼的半数有效量（ED50）。 方法 2009年7月-2009年11月择期手术患者60例，ASA I~II，年龄20~59岁，按照入室的顺序随机分为Ⅰ组（2%七氟醚组）和Ⅱ组（3%七氟醚组），预冲8%七氟醚诱导，眼睑反射消失后，调节七氟醚呼气末浓度分别维持在2%或3%，同时按照序贯法注入瑞芬太尼，瑞芬太尼注射90 s后气管插管。记录麻醉诱导前、患者意识消失时、插管前1 min、插管后1 min及插管后3 min心率、平均动脉压的变化。 结果 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量（ED50）及其相对应的95%可信区间分别为0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。 结论 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量及其相对应的95%可信区间分别为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.