【摘要】 目的评价瑞芬太尼复合异丙酚全凭静脉麻醉用于乳腺癌改良根治术对患者早期清醒的影响。方法60例乳腺癌改良根治术患者,ASAⅠ、Ⅱ级,年龄35～55岁。根据瑞芬太尼输注速度的不同,随机分为3组(Ⅰ、Ⅱ、Ⅲ组),每组20例。手术开始前15min,I组微量泵恒速输注瑞芬太尼3μg.kg-1.h-1,Ⅱ组微量泵恒速输注瑞芬太尼4μg.kg-1.h-1,Ⅲ组微量泵恒速输注瑞芬太尼5μg.kg-1.h-1;3组均给予异丙酚,初始剂量为8mg.kg-1.h-1,与瑞芬太尼同时输注。待患者意识消失,给予喉罩,术中保留自主呼吸。手术开始后根据患者双频谱指数(BIS)值、体动及呼吸情况追加麻醉药物。术中患者BIS值维持在45～65,若出现体动,则追加瑞芬太尼0.3μg/kg。于苏醒期监测BIS值及OAA/S评分,并记录意识恢复时间、定向力恢复时间及不良反应。结果3组患者苏醒时间分别(3.1±0.6)min、(3.3±0.6)min、(3.2±0.7)min;定向力恢复时间分别为(4.2±0.7)min、(4.3±0.5)min、(4.6±0.8)min。3组患者唤之睁眼时间、定向力恢复时间、出手术室时间差异无统计学意义(P>0.05)。呼吸抑制的发生率Ⅲ组较I、II组高(P<0.05)。3组患者均出现不同程度的手术后躁动。结论瑞芬太尼复合异丙酚全凭静脉麻醉早期清醒迅速完全,苏醒时间为5min左右。由于瑞芬太尼半衰期短,患者术后很快就会感到疼痛,术后镇痛应及时开始。更多还原

【Abstract】 Objective To investigate the effect of total intravenous anesthesia with propofol-remifentanil on early consciousness from anesthesia in patients undergoing mastectomy.Methods Sixty ASA Ⅰ～Ⅱ female patients(35～55 yr)undergoing elective radical mastectomy were enrolled in this study.The patients were randomly divided into three groups(group Ⅰ,Ⅱ,Ⅲ),20 cases in each group.The patients in group Ⅰreceived continuous infusion of remifentanil at a rate of 3 μg·kg-1·h-1,and 4 μg·kg-1·h-1 in group II and 5 μg·kg-1·h-1 in group Ⅲ.At the same time propofol continuous infusion was started at a rate of 8 mg·kg-1·h-1.Laryngeal mask airways(LMA)were inserted when the patients lost their consciousness.Anesthesia maintained with propofol and remifentanil by spontaneous ventilation.BIS was maintained at 45～65 during anesthesia.A high dose of remifentanil(0.3 μg/kg)was given via i.v when movement of limbs was occurred.The recovery time of consciousness and orientation after termination of anesthesia and discharged from operation room,and the awareness during operation was compared among the 3 groups.BIS and OAA/S scores after operation were also monitored and assessed.Results Consciousness recovery time of 3 groups was(3.1±0.6)min,(3.3±0.6)min,(3.2±0.7)min respectively;orientation recovery time of 3 groups was(4.2±0.7)min,(4.3±0.5)min,(4.6±0.8)min respectively.The duration from termination of anesthesia to eye opening at requestand recovery of orientation and discharging time from operation room were similar among the 3 groups(P>0.05).The incidence of respiratory inhibition in group Ⅲ were higher than that in group Ⅰ and group II(P<0.05).There were some restless patients after operation in 3 groups.Conclusion Early consciousness from anesthesia with propofol-remifentanil is fast and complete.The postoperative analgesia should be started timely because of the shorter half time period of remifentanil.更多还原