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瑞芬太尼复合七氟醚对自主呼吸恢复的影响

方开云1,史静2,何祥1,谭立2   

  1. 1. 贵州省人民医院
    2. 贵阳医学院附属医院
  • 收稿日期:2010-09-06 修回日期:2011-01-04 出版日期:2011-09-15 发布日期:2011-09-15
  • 通讯作者: 方开云

A clinical study of spontaneous reversal of depressed ventilatory during sevoflurane-remifentanil anesthesia

  • Received:2010-09-06 Revised:2011-01-04 Published:2011-09-15 Online:2011-09-15
  • Contact: Kai-Yun Fang

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摘要： 【摘要】 目的 观察瑞芬太尼复合七氟醚在全麻维持中对自主呼吸恢复影响。方法 择期手术患者400例，ASAⅠ~Ⅱ，年龄18-63岁，体重52~80kg，随机分为2组（n=200）：Ⅰ组吸入七氟醚1.0MAC，间断注射芬太尼1μg/kg；Ⅱ组持续输注瑞芬太尼0.1~0.2μg.kg-1.min-1，吸入七氟醚1.0MAC；两组患者均根据自主呼吸恢复，追加维库溴铵0.03mg/kg。记录术中自主呼吸出现的情况、维库溴铵用量、术毕TOF恢复至≥0.9的病例及拔管时间。结果 剔除手术时间小于2小时病例，Ⅰ组有189例，Ⅱ组有187例纳入统计学处理。Ⅰ组有189例患者术中出现自主呼吸，占总病例100%，Ⅱ组为12例，占总病例6.4%，；Ⅱ组患者维库溴铵用量显著少于Ⅰ组（p<0.05）；停药即刻TOF≥0.9病例Ⅰ组有48例，Ⅱ组有163例，差异有统计学意义（p<0.05）；Ⅱ组拔管时间显著早于Ⅰ组（p<0.05）。结论 瑞芬太尼与七氟醚合用，可以达到较好呼吸抑制作用，从而明显减少维库溴铵用量。

关键词: 瑞芬太尼, 七氟醚, 全身麻醉, 自主呼吸

Abstract: 【Abstract】Objective To investigate the effect of sevoflurane-remifentanil anesthesia on spontaneous ventilation recovery. Methods Four hundreds ASAⅠorⅡpatients aged 18-63 yr，weighing 52~80 kg scheduled for elective surgery were randomly divided into 2 groups(n=200 each): sevoflurane group(Ⅰ) and sevoflurane-remifentanil group(Ⅱ).Anesthesia was induced with fentanyl,propofol and vecuronium.The patients were mechanically ventilated after tracheal intubation. Anesthesia were maintained with 1MAC sevoflurane and intermittent iv boluses of fentanyl in groupⅠand 1MAC sevoflurane and iv infusion remifentanil 0.1~0.2μg.kg-1.min-1 in group Ⅱ.All patients recieved in bolus of vecuronium when spontaneous respiratory was reversed.The times of spontaneous ventilation recovery per patient,the amount of vecuronium,the cases of TOF≥0.9 at immediately point of opertion ending and the duration of tracheal extubation were recorded.Results The 189 cases in groupⅠand 187 cases in group Ⅱwere taken into statistical analysis .There were a higher incidence of spontaneous ventilation recovery and more amount of vecuronium in groupⅠthan that in group Ⅱ（p<0.05）; the cases of TOF≥0.9 at immediately point of opertion ending in groupⅠ(48 cases) were significantly less than that in group Ⅱ(163cases)（p<0.05）; meanwhile,the duration of tracheal extubation was shorter in group Ⅱthan that in groupⅠ（p<0.05）.Conclusion Sevoflurane-remifentanil anesthesia caused so strongly respiratory depression that less amount of vecuronium was required during perioperative.

Key words: Remifentanil, Sevoflurane, General anesthsia, Spontaneous ventilation