【摘要】 目的探讨食管癌根治术靶控输注(TCI)舒芬太尼或瑞芬太尼复合吸入七氟醚的麻醉效果。方法择期行食管中段癌根治术患者30例,ASAⅠ级或Ⅱ级,随机分为舒芬太尼组(SF组)和瑞芬太尼组(RF组),每组15例。麻醉诱导设定异丙酚血浆靶浓度3 mg/L,舒芬太尼和瑞芬太尼血浆靶浓度分别为0.6、6μg/L,2组分别TCI异丙酚及舒芬太尼或瑞芬太尼。麻醉维持舒芬太尼或瑞芬太尼血浆靶浓度不变,停止TCI异丙酚,持续吸入七氟醚,维持呼气末七氟醚浓度0.7～1.5MAC,术后行自控静脉镇痛(PCIA)。监测患者围术期收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)及心率(HR)变化,观察麻醉苏醒情况,记录术后Ramsay镇静评分及视觉模拟镇痛评分(VAS),随访术后麻醉相关并发症发生情况。结果与RF组比较,SF组围术期血流动力学更加平稳,手术结束至呼吸恢复、呼之睁眼、气管拔管和定向力恢复时间均较长(P<0.05)。SF组拔管后出现暂时性呼吸抑制2例;RF组诱导时给与麻黄碱6 mg 4例,麻醉苏醒期出现烦躁3例。2组术后镇痛期间均未发生恶心、呕吐、皮肤瘙痒及呼吸抑制,但RF组追加曲马多例数多于SF组。结论舒芬太尼TCI时需要提前较长时间停药,而瑞芬太尼TCI可控性优于舒芬太尼,适用于麻醉维持。但舒芬太尼镇痛作用强,术后患者自控镇痛优于瑞芬太尼。更多还原

【Abstract】 Objective To observe the effects of sufentanil or remifentanil by TCI combined with sevoflurane inhalation on patients undergoingesophagectomy.Methods Thirty ASAⅠorⅡpatients(age range 45～64 yr)with BMI<30 kg/m2 undergoing esophagectomy were randomly divided into 2 groups(n=15): sufentanil group(SF) and remifentanil group(RF).Anesthesia was induced with propofol and sufentanil or remifentanil,all the patients were given drugs by TCI.The target plasma concentration(CT) of propofol was set at 3 μg/ml and that of sufentanil at 0.6 ng/ml(SF) and remifentanil at 5 ng/ml(RF).Anesthesia was maintained with sevoflurane 0.7～1.5 MAC inhalation and propofol TCI off.CT of sufentanil and remifentanil were unchanged during maintenance of anesthesia.All the patients received PCIA after operation.BP and HR were continuously monitored and recorded.The recovery profiles and the complications after operation were recorded.Results The perioperative hemodynamics was more stable in group SF than that in group RF.The time from the end of operation to respiration recovery,to eye open,to extubation and to orientation recovery were all significantly longer in group SF than that in group RF.The effect of PCIA of sufentanil was superior to that of remifentanil(P<0.05).Conclusion The controlliability of remifentanil by TCI is better than that of sufentanyl,which refers to maintenance of anesthesia.But sufentanil is superior to PCIA.更多还原