目的:观察等效剂量瑞芬太尼和芬太尼诱导气管插管对小儿血流动力学的影响。方法:40例择期行全麻患儿随机分为瑞芬太尼组和芬太尼组,麻醉诱导使用咪唑安定0.15mg/kg、丙泊酚2.5mg/kg、芬太尼2.5μg/kg或瑞芬太尼2μg/kg和维库溴铵0.1mg/kg。分别于麻醉诱导前(T0)、诱导后2min(T1)、插管后1、2min(T2、T3)记录心率、收缩压和舒张压。结果:两组诱导前血流动力学指标相似。与T0时比较,两组患儿T1时收缩压、舒张压均降低(Plt;0.05或Plt;0.01),心率均减慢(Plt;0.05或Plt;0.01);瑞芬太尼组T2.T3时收缩压、舒张压降低(Plt;0.05或Plt;0.01),心率减慢(Plt;0.05);芬太尼组T2、T3时收缩压、舒张压升高(Plt;0.05),心率增快(Plt;0.05)。与芬太尼组比较,瑞芬太尼组T1、T2和T3时收缩压、舒张压均降低(Plt;0.05),心率减慢(Plt;0.05)。结论:瑞芬太尼比等效剂量芬太尼能更好地抑制小儿全麻诱导气管插管时的心血管反应。
ObjectiveTo evaluate the feasibility and efficiency of patient-controlled analgesia and sedation (PCAS) with propofol and remifentanil for colonoscopy in elderly patients. MethodsSixty elderly patients preparing for painless colonoscopy between May and September 2015 were randomly allocated into PCAS group and total intravenous anesthesia (TIVA) group with 30 patients in each. In the PCAS group, the mixture of remifentanil and propofol at 0.6 mL/(kg·h) was pumped continuously after an initial bolus of 0.05 mL/kg mixture. The examination began three minutes after the infusion was finished. Patients could press the self-control button. Each bolus delivered 1 mL and the lockout time was 1 minute. In the TIVA group, patients received fentanyl at 1 μg/kg and midazolam at 0.02 mg/kg intravenously, and accepted intravenous propofol at 0.8-1.0 mg/kg two minutes later. The examination began when the patients lost consciousness. ResultsA significant decline of mean arterial blood pressure was detected within each group after anesthesia (P < 0.05). The decrease of mean blood pressure in the TIVA group was more significant than that in the PCAS group (P < 0.05). The heart rate, pulse oxygen saturation and respiratory rate decreased significantly after anesthesia in both the two groups (P < 0.05), while end-tidal CO2 increased after anesthesia without any significant difference between the two groups (P > 0.05). The induction time, time to insert the colonoscope to ileocecus, and total examination time were not significantly different between the two groups (P > 0.05). As for the time from the end of examination to OAA/S score of 5 and to Aldrete score of 9, the PCAS group was significantly shorter than the TIVA group (P < 0.05). ConclusionPCAS with remifentanil and propofol can provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery compared with TIVA.
【摘要】 目的 比较瑞芬太尼、丙泊酚、艾司洛尔用于支撑喉镜手术气管插管时患者的心血管反应。 方法 选取2009年1-3月就诊的60例拟于全身麻醉下行择期支撑喉镜下声带息肉切除术的患者，随机分为丙泊酚组、艾司洛尔组和瑞芬太尼组，每组20例。麻醉诱导采用咪达唑仑、芬太尼和丙泊酚，患者意识消失后给予琥珀胆碱。1 min后各组分别给予丙泊酚2 mg/kg、艾司洛尔1 mg/kg和瑞芬太尼1 μg/kg。30 s后进行气管插管。记录患者诱导前及插管前、插管后1、3、5 min的心率和血压水平。 结果 各组插管前的收缩压和心率较诱导前明显降低，插管后1、3 min的收缩压和心率较插管前升高（Plt;0.05)。丙泊酚组和艾司洛尔组插管后的收缩压较瑞芬太尼组升高（Plt;0.05)。丙泊酚组插管后心率较瑞芬太尼组增加（Plt;0.05)。 结论 对行支撑喉镜手术的患者，气管插管前30 s给予1 μg/kg瑞芬太尼较2 mg/kg丙泊酚和1 mg/kg艾司洛尔能更有效地减轻气管插管时的血流动力学反应。【Abstract】 Objective To assess the different effects of remifentanil, propofol, and esmolol on hemodynamic responses during intubation in CO2 laser endolaryngeal microsurgery (CO2-LELM). Methods A total of 60 patients aged from 18 to 65 years, admitted from January to March 2009 and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group, an esmolol group, and a remifentanil group. Anesthesia was induced with midazolam (0.015-0.02 mg/kg), fentanyl (1 μg/kg), and propofol (1 mg/kg). After the patients became unconscious, succinylcholine (1 mg/kg) was given one minute later. Then the patients in the three groups received propofol (2 mg/kg), esmolol (1 mg/kg), and remifentanil (1 μg/kg), respectively. Intubation was performed 30 secconds later. Heart rate (HR) and systolic blood pressure (SBP) were measured noninvasively before general anesthesia induction (baseline, Tb), just before intubation(Ti), and one, three, and five minutes after intubation (T1, T3, T5). Results The demographic data including age, sex and body weight were comparable in the three groups. Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti (Plt;0.05). After intubation, SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group (Plt;0.05), and HR in the propofol group was significantly higher than that in the remifentanil group (Plt;0.05). Conclusion In patients with CO2-LELM, remifentanil (1 μg/kg) administrated 30 seconds before intubation is maximal effective compared with propofol (2 mg/kg) or esmolol (1 mg/kg) in attenuating the hemodynamic responses to oraltracheal intubation.
目的 探讨丙泊酚复合瑞芬太尼在患者清醒状态下实施无痛肠镜法的可行性。 方法 2011年7月－2012年7月，将160例行无痛肠镜检查的患者随机分为两组: A组用芬太尼复合丙泊酚麻醉,其中男38例，女42例，平均年龄（48 ± 16）岁，平均体重（53.37 ± 9.5）kg；B组以阿托品0.25～0.5 mg缓慢静脉注射，继而以瑞芬太尼+丙泊酚复合液缓慢静脉滴注，使患者保持清醒状态，其中男43例，女37例，平均年龄（49 ± 15）岁，平均体重（54.26 ± 8.3）kg。观察两组患者检查中血压、心率、呼吸、血氧饱和度变化，检查中体动反应，检查后苏醒时间、定向力恢复、行走时间、离室时间，以及对检查过程的记忆情况。 结果 两组患者均能顺利完成检查，术中记忆率均低，差异无统计学意义（P＞0.05）。A组患者循环改变、心动过缓、低氧血症、以及体动反应明显高于B组（P＜0.05），B组患者苏醒时间、定向力恢复、行走时间、离室时间，明显短于A组（P＜0.05）。 结论 瑞芬太尼-丙泊酚复合液伍用阿托品能够安全应用于患者清醒状态下实施的无痛肠镜检查，具有良好的临床推广价值。
Objective To systematically review the clinical effectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Methods Databases including The Cochrane Library (Issue 3, 2013), the database of the Cochrane Anesthesia Group, MEDLINE, EMbase, PubMed, Ovid, Springer, CNKI, VIP and WanFang Data were electronically searched from inception to May 2013 for the randomized controlled trials (RCTs) of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirteen trials involving 647 patients were finally included. The results of meta-analysis showed that: a) for hemodynamic changes, MAP decreased in the remifentanil-propofol group after induction and decreased 5 minutes after intubation, but no significant difference was found between the two groups; the two groups were alike in MAP changes during craniotomy and extubation, and in HR changes after induction, 5 minutes after intubation, during craniotomy and extubation, with no significant difference. b) The result of intra-operative wake-up test showed that, there was no significant difference in the sedative effect and the time of awaking between the two groups. c) For emergence time and extubation time, compared with the sufentanil-propofol group, emergence time and extubation time were significantly shorter than those in the remifentanil-propofol group. d) For side effects, there was no significant difference in side effects (such as post-operative nausea, vomiting, respiratory depression, restlessness, chills and hypotension) between the two groups. And e) for post-operative pain, compared with the remifentanil-propofol group, post-operative 1-h and 2-h VAS were lower and the number of who need additional analgesic drugs within 24 h after operation was less in the sufentanil-propofol group, with significant differences. Both groups used the similar dosage of propofol with no significant difference. Conclusion Compared with the remifentanil-propofol group, hemodynamics changes in the sufentanil-propofol group is steadier after induction and during intubation. Patients in the sufentanil-propofol group are better in postoperative awakening quality. But they are alike in the incidence of side effects and propofol dosage.
The present study was to investigate the effects of infusing remifentanil-poly-caprolactone (REM-PCL) through the abdominal aorta on spinal cord ischemia reperfusion injury (SCIRI). The model of SCIRI was created by clamping the infrarenal aortic in thirty-six New Zealand white rabbits, which were randomly divided into sham group (group S), control group (group C), and REM-PCL group (group R) with 12 rabbits in each one. The spinal cord microcirculatory blood flow (SCMBF) and blood flow rate (BFR) were monitored before ischemia, 15 min, 30 min, 60 min and 120 min after reperfusion, respectively. Neurologic Function was evaluated before ischemia, 6h, 12h and 24h after reperfusion. The concentration of serum neuron-specific enolase (NSE), interleukin-lβ (IL-lβ) and interleukin-8 (IL-8) were monitored before ischemia, 45 min after ischemia, 30 min, 60 min, 6 h, 12 h and 24 h after reperfusion. The abnormal rate of motor neuron of spinal cord tissues and the level of superoxide dismutase (SOD), reactive oxygen species (ROS), glutathione peroxidase (GSH-PX), malondialdehyde (MDA), total anti-oxidation capacity (T-AOC) and mitochondrial swelling degree (MSD) in neural mitochondria were determined before ischemia, 45 min after clamping, 60 min and 120 min after reperfusion. As a result, the neural mitochondrial SOD, GSH-PX and T-AOC decreased while ROS, MDA, MSD, IL-lβ, IL-8 and NSE distinctly increased after clamping of the abdominal aorta as compared to the value before ischemia in group C (P < 0.01). Neurologic function scores recovered more rapidly in group R than those in group C during reperfusion (P < 0.01). The neural mitochondrial SOD, GSH-PX and T-AOC were distinctly higher while ROS, MDA, MSD, IL-lβ, IL-8 and NSE were distinctly lower in group R than those in group C (P < 0.01). The abnormal rate of motor neuron was significantly higher in group C during reperfusion than that in group R (P < 0.01). It has been shown that the intra-aortic REM-PCL infusion can alleviate SCIRI by inhibiting inflammatory response and improving mitochondrial anti-oxidation capacity.
目的:比较瑞芬太尼联合异丙酚或依托咪酯全麻在腹腔镜妇科手术中的临床效果。方法:择期腹腔镜妇科手术80例,随机分成瑞芬太尼异丙酚组(RP组)和瑞芬太尼依托咪酯组(RE组),各40例。两组全麻诱导用药相同,维持麻醉RP组采用瑞芬太尼联合异丙酚、RE组采用瑞芬太尼联合依托咪酯。记录基础值、诱导后、插管后1 min、3 min、气腹时、气腹后10、20、30、40 min的动脉收缩压(SBP)、舒张压(DBP)、心率(HR);记录停药至自主呼吸恢复、睁眼、拔除气管导管、恢复定向能力的时间;记录清醒即刻及清醒后1、2、4、8、12、16、20、24 h患者疼痛程度,采用VAS评分;记录24 h内不良反应发生情况。 结果: 两组SBP、DBP均在诱导后明显低于基础值(Plt;001), 插管后恢复,气腹开始后趋于平稳;两组HR均在诱导后减慢(Plt;001),插管后及气腹开始时恢复。RP组自主呼吸恢复、呼之能睁眼、拔除气管导管及恢复定向能力的时间均明显短于RE组(Plt;001)。麻醉清醒即刻、清醒后1、2、4、8 h VAS评分RE组明显低于RP组(Plt;005),12、16、20、24 h VAS评分两组比较无显著性差异(Pgt;005)。术后发生恶心呕吐患者数RP组明显减少(Plt;005)。 结论:全麻行腹腔镜妇科手术时,瑞芬太尼联合异丙酚或依托咪酯都能缓解气腹及手术引起的血流动力学变化,瑞芬太尼联合异丙酚术后苏醒快且能明显降低术后恶心呕吐的发生率,但术后疼痛较为严重。
目的:对照研究在全麻剖宫产术中应用瑞芬太尼和氯胺酮诱导对母婴的影响。方法:选择100例禁忌椎管内麻醉而须行全麻剖宫产手术的患者,分为两组,氯胺酮组静注异丙酚1.5mg/kg+氯胺酮1mg／kg+琥珀胆碱1.5mg／kg;瑞芬太尼组静注异丙酚1.5mg/kg+瑞芬太尼1μg/kg+琥珀胆碱1.5mg／kg诱导插管,胎儿娩出后均静注芬太尼2g／kg、泵注异丙酚3mg/(kg·h)和吸入异氟醚0.5MAC维持麻醉,阿曲库铵维持肌松。结果:瑞芬太尼组插管(切皮)后血压、心率升高幅度显著小于氯胺酮组,两组新生儿1min、5min Apgar评分无明显差异。结论:瑞芬太尼用于产科全麻优于氯胺酮,安全可行。
目的 探讨丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤的保护作用以及作用机制。 方法 2009年6月－2011年12月选择择期需阻断肝门的肝脏手术患者40例，随机分为丙泊酚-瑞芬太尼组（P组）和异氟醚组（I组），每组20例。在术前（T0）和肝门阻断开放后30 min（T1）、60 min（T2）、6 h（T3）、24 h（T4）、72 h（T5）分别抽取动脉血，测定天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）和肿瘤坏死因子α（TNF-α）的含量。 结果 两组AST、ALT、TNF-α较术前均有增高，差异有统计学意义（P＜0.05）；P组增高幅度明显低于I组，差异有统计学意义（P＜0.05）。 结论 丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤具有保护作用，抑制TNF-α的产生可能为其作用机制之一。
目的 系统评价瑞芬太尼用于全身麻醉下剖宫产时对新生儿的影响。 方法 检索Cochrane Library、PubMed、OVID、EMbase、CNKI、万方等中外数据库，收集1990年－2012年关于瑞芬太尼用于全身麻醉下剖宫产的临床随机对照研究。按Cochrane系统评价方法评估文献质量，用Revman 5.1软件对提取的数据进行Meta分析。 结果 共纳入10项研究，包括342例产妇。与空白对照组相比，瑞芬太尼降低新生儿1 min Apgar评分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生时脐动脉pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生时窒息发生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；当诱导剂量为1.0～1.5 μg/kg时，对5 min Apgar评分无影响[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。 结论 瑞芬太尼用于全身麻醉剖宫产可减轻新生儿酸中毒，但是会对新生儿产生一过性的呼吸抑制。