芬太尼与瑞芬太尼诱导对腹腔镜胆囊切除术患者苏醒期躁动影响的比较
Comparison of anesthesia induction with fentanyl and remifentanil on agitation during anesthesia recovery period in laparoscopic cholecystectomy patients
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摘要: 目的:比较芬太尼与瑞芬太尼诱导对腹腔镜胆囊切除术患者全麻后苏醒期躁动(RS)的影响。方法:选择ASAⅠ或Ⅱ级腹腔镜胆囊切除术患者60例,随机分为瑞芬太尼组(R组)和芬太尼组(F组)各30例。诱导药物为:R组瑞芬太尼1g/kg、咪达唑仑3 mg、丙泊酚2 mg/kg、罗库溴铵0.6 mg/kg;F组除芬太尼3.0g/kg代替瑞芬太尼外,其他用药同R组。麻醉维持为瑞芬太尼0.2gkg-1min-1,丙泊酚2 mgkg-1h-1,微量泵恒速输入;持续吸入1%~2%七氟烷。观察2组拔管前、拔管时和拔管后10 min的RS评分以及麻醉后复苏时间和并发症发生情况。结果:R组拔管前、拔管时和拔管后10 min RS评分均明显高于F组(P0.01),2组患者自主呼吸恢复时间、呼之睁眼时间差异均无统计学意义(P0.05)。结论:腹腔镜胆囊切除术中小剂量芬太尼诱导可有效减少瑞芬太尼麻醉后RS。Abstract: Objective:To compare the anesthesia induction with fentanyl and remifentanil on agitation during anesthesia recovery period in laparoscopic cholecystectomy patients． Methods:ASAⅠ or Ⅱ laparoscopic cholecystectomy patients were randomly divided into remifentanil group(R group) and fentanyl group(F group)，to observe restlessness score． Inducing drugs:R group remifentanil 1 g/kg，midazolam 3 mg，propofol 2 mg/kg，rocuronium 0． 6 mg/kg;F group were fentanyl 3． 0 g/kg replace remifentanil，others medication with agree R group accord． To maintain anaesthesia by micro pump constant velocity input remifentanil 0． 2 gkg－1 min－1propfol 2 mgkg－1h－1and inhaling 1% － 2% sevoflurane． Compare agitation score in two groups before extubation， extubation，10 min after extubation． Results:Restlessness score in R group were higher than those in F group before extubation， extubation，10 min after extubation(P 0． 01)． Differences of two groups of patients with spontaneous breathing recover time，awake time were not significant(P ＞0． 05)． Conclusions:Anesthesia induction with fentanyl can effectively reduce agitation during anesthesia recovery period in laparoscopic cholecystectomy patients．
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