医药学论文：颅内手术中异丙酚联合不同阿片类药物持续静脉输注的疗效比较

【关键词】 阿片类,异丙酚,持续静脉输注

　　【摘要】目的 观察异丙酚联合芬太尼、舒芬太尼、瑞芬太尼持续静脉输注在颅内手术中的应用，比较其优劣。 方法 颅内手术患者75例，年龄20～60岁，性别不限，ASAⅡ～Ⅲ级；随机分成芬太尼组、舒芬太尼组、瑞芬太尼组。监测术中血流动力学变化，观察患者苏醒和并发症情况，进行术后VAS疼痛及OAAS意识评分。结果 芬太尼在开颅、关颅、拔管时平均动脉压（MAP）、心率（HR）均明显高于基础值（P< 0.05），舒芬太尼、瑞芬太尼在开颅、颅内手术期、关颅均低于基础值（P< 0.05）；颅内手术各期芬太尼的MAP、HR值均高于舒芬太尼、瑞芬太尼组（P< 0.05），而在开颅、颅内手术期瑞芬太尼要明显低于舒芬太尼组（P< 0.05）；三组患者针刺疼痛时间舒芬太尼最长11.7±1.6（P< 0.05），瑞芬太尼最短6.0±1.2（P< 0.05）；在拔管5minOAAS评分芬太尼组最低，为2.0±0.3（P< 0.05），而舒芬太尼、瑞芬太尼组间并不存在差异（P>0.05）；但术后1小时、2小时、4小时舒芬太尼组VAS疼痛评分明显低于芬太尼、瑞芬太尼组（P< 0.05），12小时达到高峰，8小时后无统计学差异（P>0.05）；术后恶心呕吐（PONV）发生率芬太尼组明显高于舒芬太尼、瑞芬太尼组（P< 0.05）。结论 瑞芬太尼联合异丙酚持续静脉输注用于颅内手术优于芬太尼或舒芬太尼，而舒芬太尼优于芬太尼，但认为术后的作用舒芬太尼最佳。

　　【关键词】阿片类，异丙酚，持续静脉输注

　　Compare to Different Kind of Opioids Combining With Propofol as Continuous Intravenous Infusion in Intracranial Surgery

　　【Abstract】 Objective Observing the application of propofol combining with fentanyl, or sufentanil, remifentanil in intracranial surgery, superior or inferior. Method The patients for intracranial surgery are 75 cases, age ranges 20 to 60, no sex restriction, ASAⅡ～Ⅲ; dividing patients into three groups: fentanyl group, sufentanil group, remifentanil group. Monitoring blood flow indicators at operations, observing waking and complications, evaluating VAS and OAAS grades. Results Fentanyl group on Mean Artery Pressure（MAP）, Heart Rate（HR） during opening or closing skull or extubation is significantly higher than basic evaluations（P< 0.05）, but sufentanil group and remifentanil group is lower than basic evalutions during opening or closing skull and intracranial period（P< 0.05）; fentanyl group MAP, HR in every intracranial episodes is higher than sufenanil group and remifentanil group（P< 0.05）, but remifentanil group is significantly lower than sufentanil group during opening skull or intracranial period（P< 0.05）; pinprick reaction emergence time of sufentanil group is longest, 11.7±1.6（P< 0.05）, but remifentanil group is shortest, 6.0±1.2（P< 0.05）; 5 minutes after extubation, OAAS grades of fentanyl group are lowest, 2.0±0.3 at 12h, no variance between sufentanil group and remifentanil group（P>0.05）; but VAS grades at 1h, 2h, 4h points after operations, sufentanil group is significantly lower than fentanyl group, or remifentanil group（P< 0.05）, at 12h point, at peak, but no statistic variance after 8h; PONV rate of fentanyl group is significantly higher than sufentanil group, or remifentanil group（P< 0.05）. Coclusions Remifentanil combining with propofol is superior to fentanyl, or sufentanil in intracranial surgery anesthesia by continuous intravenous infusion, but sufentanil is superior to fentanyl, but supposing that sufentanil is best postoperatively.

　　【key】 opioids, propofol, continuous intravenuous infusion

　　阿片受体激动剂芬太尼、舒芬太尼、瑞芬太尼广泛应用于手术麻醉镇痛，具有各自显著的药理学特性；与短效静脉麻醉药异丙酚具有协同作用[1]，药代动力学模式互为补充。持续静脉输注麻醉具有维持平稳、可控性好、简便易行等特点，适用于时间较长、需维持术中生命体征稳定且刺激强度较大手术，如颅内手术等。本研究观察了异丙酚联合芬太尼、舒芬太尼、瑞芬太尼持续静脉输注在颅内手术中的应用，比较其优劣。