丙泊酚瑞芬太尼靶控全静脉麻醉用于眶内手术

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1、丙泊酚瑞芬太尼靶控全静脉麻醉用于眶内手术【摘要】目的观察丙泊酚、瑞芬太尼靶控输注（TCI）全静脉麻醉用于眼眶手术的可行性与安全性。方法择期眶内手术成年患者76例，ASAⅠ～Ⅱ级，随机分为A、B两组各38例。A组以丙泊酚、瑞芬太尼TCI静脉诱导，插管后全程TCI维持麻醉；B组常规诱导插管后，吸入七氟烷＋N2O维持。无创心功能血流动力学监测系统全程监测，记录诱导前，气管插管即刻，插管后1、3、5min、切皮、拔管即刻、拔管后1、5min循环动力学变化，停止输注至气管导管拔除时间，麻醉、手术中不良事件及处理。结果两组患者术前一般情况差异无统计学意义，麻醉诱导及维持期间血流动力学均较平稳。A

2、组拔管时间（10.6±2.03）min短于B组（17.14±2.84）min，P=0.031。术后恶心、呕吐（0vs.5，P=0.021）；躁动（0vs.4,P=0.04）低于B组（P<0.05）。结论丙泊酚、瑞芬太尼TCI用于眶内手术麻醉，能有效预防麻醉诱导刺激和手术操作应激反应，循环波动小；术野稳定，便于手术操作；术后清醒迅速，彻底，不良反应少，辅以适当术后镇痛，能满足眶内手术需求。【关键词】丙泊酚；瑞芬太尼；靶控输注［Abstract］ObjectiveToinvestigatethefeasibilityandsafetyoftargetcontrolledinfusi

3、on（TCI）withpropofoland9remifentanilintotalintravenousanesthesiaforophthalmicorbitalsurgery.MethodsPropofolandremifentanilTCIwasusedforinductionandmaintenanceingroupA（experimentalgroup）.AnesthesiamaintenancewaswithinhaledsevofluranecombinedwithnitrousoxideingroupB（controlgroup）followingconventio

4、nalpracticeintravenously.Esmeronewasinjectedintermittentlyintravenouslytokeepmusclesrelaxingduringtheoperationinbothgroups.Non-invasivehaemodynamicswasmonitorredduringwholestageandchangesofcirculatingparameterswererecordedpre-induction,righttrachealintubationand1,3,5minutespost-intubation,atinc

5、ision,rightextubationand1,5minutespost-extubation,stopofTCItoextubationandadverseeventsandtherapiesduringtheoperationwererecord.Flurbiprofenwasusedforpost-operationpainrelief.ResultsTherewerenostatisticalsignificancesinpatients’ASAgeneralstatusandage,gender,weight,heightbetweentwogroups.Haemody

6、namicsofbothgroupswasstableduringtheprocedures.AwaketimewasmuchshorteringroupAthanthatofingroupB［（10.6±2.03）minvs.（17.14±2.84）min，P=0.031］.PostoperativenauseaandvomitingandrestlessnessweremuchhigheringroupAthanthatofingroupB（PONV,0vs.5,P=0.021;restlessness0vs.4,P=0.04）.ConclusionPropofol9plusre

7、mifentanilTCIcaneffectivelypreventpatient,whounderwentophthalmicorbitalsurgery,fromstressinducedbyperformanceofanasthesiaandoperation，haemodynamicsiswithlittlefluctuation,thecampusvisualisofoperationismuchstableandeasytomanipulate