芬太尼、雷米芬太尼复合丙泊酚全凭静脉麻醉在乳腺手术中的应用

目的观察芬太尼、雷米芬太尼复合丙泊酚全凭静脉麻醉（TIVA）在乳腺手术应用中血流动力学的变化及苏醒效果。方法 60例全麻下乳腺包块切除手术患者,ASAⅠ或Ⅱ级,随机分为两组：芬太尼、雷米芬太尼复合丙泊酚TI-VA组（F组）和雷米芬太尼复合丙泊酚TIVA组（RF组）,每组30例。麻醉诱导给予利多卡因1 mg/kg、顺时阿曲库铵0.1mg/kg、咪唑安定0.04mg/kg、丙泊酚1～1.5mg/kg,F组给予芬太尼3～4μg/kg,RF组给予雷米芬太尼1μg/kg。意识消失后置入4#喉罩（LMA）。麻醉维持均以雷米芬太尼0.1～0.25μg/（kg.min）、丙泊酚5～8mg/（kg.h）微量泵持续输注。两组患者均在缝皮结束前2min停麻醉药。记录诱导、切皮前后血流动力学的变化、苏醒时间、术后24h疼痛VAS评分及不良反应。结果与T0比较,两组T1和T3时BP和HR下降,P〈0.05或P〈0.01,差异有统计学意义;组间比较差异无统计学意义。苏醒时间R组长于RF组,两组间比较差异无统计学意义。术后2h内VAS评分R组低于RF组（P〈0.01）,差异有统计学意义。两组术后不良反应各有1例。结论以芬太尼诱导、雷米芬太尼复合丙泊酚维持的TIVA平稳、苏醒快、舒适,适用于乳腺包块手术。

Application of fentanil and remifentanil combined with propofol anesthesia in breast operation

Objective To investigate the effects of fentanil and remifentanil combined with propofol on hemodynamics and reviviscency in patients undergoing breast operation.Methods Sixty cases（ASA Ⅰor Ⅱ） undergoing breast operation were randomly allocated to two groups with 30 cases each.In group R,patients were induced with lidocaine 1mg/kg,cisatracurium 0.1 mg/kg,midazolame 0.04 mg/kg,propofol 1～1.5mg/kg and fentanil 3～4μg/kg.In group RF,patients were induced with lidocaine 1mg/kg,cisatracurium 0.1 mg/kg,midazolame 0.04 mg/kg,propofol 1～1.5mg/kg and remifentanil 1μg/kg.Then,they were laid LMA and maintained with remifentanil 0.1～0.25μg/（kg·min）,propofol 5～8mg/（kg·h）.The hemodynamics before and during anesthesia and effects of reviviscency were recorded.Postoperative pain was assessed by visual analogue scale（VAS）.Side effects were observed as well.Results Comparing to T0,BP and HR decreased at T1 and T3 in group R and RF, P0.05 or P0.01,The difference of BP and HR between two groups was invalid.The difference of the time of the reviviscency between two groups was invalid.The VAS scores were decreased in group R than those in group RF（P0.01）.There was 1 case with a side-effect in group R or RF.Conclusion The anesthesia of inducing with fentanil and maintaining with remifentanil and propofol is safe,quick,comfortable and suitable for breast operation.