摘要
目的评价瑞芬太尼联合舒芬太尼对全麻手术老年患者的镇痛效果。方法将94例患者按照入院顺序分为观察组和对照组，各47例。对照组采用瑞芬太尼麻醉诱导和维持，观察组采用瑞芬太尼联合舒芬太尼麻醉诱导和维持。比较两组麻醉诱导前（T1）、插管前（r12）、插管1min后（乃）、插管5min后（T4）、进腹时（T5）、拔管1min后（T6）、拔管5min后（T7）、术后6h（T8）、术后12h（T9）、术后24h（T10）的心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SpO2）及去甲肾上腺素（NE）、肾上腺素（E）浓度等。记录拔管后躁动评分（RS）、警觉／镇静评分（OAA／S）、视觉模拟评分法（VAS）和术后24h镇痛药物的使用量，以评价联合用药在全麻老年患者中的镇痛作用。结果SpO2在组内各时间点和组间比较，差异均无统计学意义（P〉0．05）。观察组HR和MAP在T3、T5、T6、T7时段与对照组比较，差异均有统计学意义（P〈0．05）。T3、T6、T8、四时段两组NE和E浓度比较差异均有统计学意义（P〈0．05）。两组在术中循环波动调控次数，拔管10min后RS、VAS和术后24h镇痛药物用量方面比较差异有统计学意义（P〈0．05），但是拔管时间、拔管10min后OAA／S比较差异无统计学意义（P〉0．05）。结论舒芬太尼与瑞芬太尼联合应用于老年患者全麻手术，可以减轻术后疼痛，降低围术期应激反应，值得在临床中推广使用。
Objective To evaluate the analgesic effect of remifentanil combined with sufentanil on elderly patients with general anesthesia. Methods Ninety-four patients were divided into observation group and control group according to order of admission, with 47 cases in each group. Patients in control group were given remifentanil for anesthesia induction and maintenance, and patients in observation group were given remifentanil combined with sufentanil for anesthesia induction and maintenance. HR, MAP, SpO2, NE, E levels were compared before induction of anesthesia （ T1 ） , before intubation （T2） , 1 min after intubation （ T3 ）, 5 min after intubation （ T4）, into the abdomen （T5）, 1 min after extubation （T6）, 5 min after extubation （T7）, 6 h after operation （T10）. RS, OAA/S, VAS after extubation and operation were recorded, in order to evaluate the （ T8 ）, 12 h after operation （ T9 ）, 24 h after operation postoperative analgesic drugs dosages during 24 h after analgesic effect of combined medication on elderly pa- tients with general anesthesia. Results There were no significant differences in SpO2 at different time points in each group or between the two groups （ P 〉 0. 05 ）. There were significant differences in HR and MAP at T3, T5, T6 and T7 between the two groups （P 〈 0. 05 ）. There were significant differences in the levels of NE and E at T3, T6, T8, T9 between the two groups （P 〈 0. 05 ）. There were significant differences in the regulation times of blood circulation fluctuations during operation, RS and VAS at 10 min after extubation, the analgesic drugs dosage during 24 h after operation between the two groups （P 〈 0. 05）. But there were no significant differences in OAA/S at extubation and 10 min after extubation （ P 〉 0. 05 ）. Conclusions Combined medication of sufentanil and remifentanil in general anesthesia of elderly patients, can reduce postoperative pain, reduce perioperative stress response, so it is worth to be popularized in clinics.
出处
《中国实用医刊》
2014年第15期4-6,共3页
Chinese Journal of Practical Medicine
关键词
老年
舒芬太尼
瑞芬太尼
镇痛效果
Elderly
Sufentanil
Remifentanil
Analgesic effect
