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| 普鲁泊福、瑞芬太尼全凭静脉麻醉用于颈椎手术的效果评估 |
| 许平波,熊源长,李金宝,黄静霞,林福清,邓小明,XUPing-bo,XIONGYuan-chang,LIJin-bao,HUANGJing-xia,LINFu-qing,DENGXiao-ming |
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| 摘要: |
| 目的:评价普鲁泊福和瑞芬太尼全凭静脉麻醉在颈椎手术中的应用效果.方法:择期颈椎手术患者100例随机分为4组:地氟烷/瑞芬太尼(DR)组:地氟烷1～2 MAC+瑞芬太尼0.15～0.40μg·kg-1·min-1;地氟烷/芬太尼(DF)组:地氟烷1～2 MAC+芬太尼0.05 mg间断静推;普鲁泊福/瑞芬太尼(PR)组:普鲁泊福50～100μg·kg-1·min-1+瑞芬太尼0.15～0.40 μg·kg-1·min-1;普鲁泊福/芬太尼(PF)组:普鲁泊福50～100 μg·kg-1·min-1+芬太尼0.05 mg间断静推.记录术中不良心血管事件发生率、血管活性药物使用情况、拔管时间、指令性活动恢复时间.术后90 min、24 h由专人应用简化的状态-特质焦虑问卷(state-trait anxietyinventory,STAI)和视觉模拟评分法(visual analogue scale,VAS)分别评估患者的精神状态和疼痛程度,并记录恶心呕吐的发生率.结果:应用瑞芬太尼的两组(DR组和PR组)不良心血管事件、拔管时间、指令性活动恢复时间明显早于应用芬太尼的两组(DF组和PF组)(P＜0.05);术后90 min,全凭静脉麻醉的两组(PR组和PF组)STAI评分显著低于吸入麻醉的两组(DR组和DF组)(P＜0.05),但24 h后差异不显著;术后90 min、24 h,全凭静脉麻醉的两组恶心呕吐率显著低于吸入麻醉的两组(P＜0.05),且VAS评分较低,但无显著性差异.结论:普鲁泊福和瑞芬太尼全凭静脉麻醉用于颈椎手术具有血流动力学稳定、苏醒快速完全、术后精神状态好、恶心呕吐率低等优点,可广泛用于临床. |
| 关键词: 全凭静脉麻醉、地氟烷、普鲁泊福、芬太尼、瑞芬太尼、颈椎手术、恶心、呕吐、满意度 |
| DOI：10.3724/SP.J.1008.2006.00641 |
| 投稿时间：2006-03-28修订日期：2006-04-25 |
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| Total intravenous anesthesia with propofol and remifentanil in cervical vertebra surgery:an assessment of efficacy |
| 许平波,熊源长,李金宝,黄静霞,林福清,邓小明,XU Ping-bo,XIONG Yuan-chang,LI Jin-bao,HUANG Jing-xia,LIN Fu-qing,DENG Xiao-ming |
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| Abstract: |
| Objective：To assess the efficacy of total intravenous anesthesia （TIVA） with propofol and remifentanil in cervical vertebra surgery. Methods： One hundred patients receiving elective cervical vertebra surgery were randomly allocated to the following 4 groups：group DR, desflurane 1-2 MAC and remifentanil 0. 15-0.40 μg ·kg^-1 · min^-1 ; group DF,desflurane 1-2 MAC and repetitive boluses of fentanyl 0.05 mg; group PR,propofol 50-100μg · kg^-1 · min^-1 and remifentanil 0.15-0. 40 μg · kg^-1· min^-1 ;and group PF,propofol 50-100μg · kg^-1 · min^-1 and repetitive boluses of fentanyl 0.05 mg. During the anesthesia,the adverse cardiovascular response, the use of vascular active drug, time of extubation and time of directive movement resuming were recorded. The mental state and degree of pain were assessed by a blinded observer using simplified State-Trait-Anxiety Inventory （STAI） and Visual Analogue Scale （VAS） 90 min and 24 h after anesthesia. Moreover, the incidence of nausea and vomiting was also recorded. Results： The adverse hemodynamic response,time of extubation and directive movement resuming in group DR and PR were earlier than those in group DF and PF （P〈 0.05）. The STAI scores of TIVA were significantly lower than those of group DR and DF（P〈0.05） 90 min after anesthesia,but the difference disappeard after 24 h. The incidence Of nausea and vomiting in group DR and DF were significantly higher than those in other groups（P〈 0.05） 90 min and 24 h after anesthesia. There was no difference in VAS scores among all groups. Conelusion： The application of TIVA with propofol and remifentanil in cervical vertebra surgery has stable hemodynamics, quicker and complete awakening, good mental state,and reduced incidence of nausea and vomiting. It is worth recommending in clinical practice |
| Key words: total intravenous anesthesia desflurane propofol fentanil remifentanil cervical vertebra surgery nausea vomiting satisfaction |
