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| 阿芬太尼与瑞芬太尼全凭静脉麻醉用于鼻内镜手术效果的比较 |
| Comparison of total intravenous anesthesia with alfentanil and remifentanil undergoing endoscopic sinus surgery |
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| DOI：10.12089/jca.2023.11.003 |
| 中文关键词: 阿芬太尼 瑞芬太尼 全凭静脉麻醉 鼻内镜手术 |
| 英文关键词: Alfentanil Remifentanil Total intravenous anesthesia Endoscopic sinus surgery |
| 基金项目:陕西省自然科学基础研究计划项目（2021JZ-33） |
| 作者 | 单位 | E-mail | | 李岩 | 710032,西安市,空军军医大学第一附属医院麻醉与围术期医学科 | | | 加三三 | 710032,西安市,空军军医大学第一附属医院麻醉与围术期医学科 | | | 赵冰清 | 710032,西安市,空军军医大学第一附属医院麻醉与围术期医学科 | | | 汲媛美 | 710032,西安市,空军军医大学第一附属医院麻醉与围术期医学科 | | | 王丽 | 710032,西安市,空军军医大学第一附属医院麻醉与围术期医学科 | | | 何涛 | 710032,西安市,空军军医大学第一附属医院麻醉与围术期医学科 | | | 何晓兰 | 710032,西安市,空军军医大学第一附属医院麻醉与围术期医学科 | | | 曾毅 | 710032,西安市,空军军医大学第一附属医院麻醉与围术期医学科 | zengyi1014@163.com |
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| 中文摘要: |
目的 比较全凭静脉麻醉（TIVA）应用阿芬太尼或瑞芬太尼对鼻内镜手术（ESS）效果的影响。
方法 选择择期行鼻内镜手术的患者130例，男62例，女68例，年龄18～64岁，BMI 18～30 kg/m2，ASA Ⅰ或Ⅱ级。随机将患者分为两组：阿芬太尼组（A组）和瑞芬太尼组（R组）。A组麻醉诱导依次静脉注射咪达唑仑0.02 mg/kg、丙泊酚靶控输注（TCI）3 μg/ml、阿芬太尼20 μg/kg、罗库溴铵0.6 mg/kg，麻醉维持采用丙泊酚靶控输注复合阿芬太尼泵注。R组麻醉诱导依次静脉注射咪达唑仑0.02 mg/kg、丙泊酚TCI 3 μg/ml、瑞芬太尼1 μg/kg、罗库溴铵0.6 mg/kg，麻醉维持采用丙泊酚靶控输注复合瑞芬太尼泵注。记录术中高血压、心动过速、低血压、心动过缓等血流动力学不良反应发生情况，术后30、60 min、24 h的疼痛程度，拔管时间，术后24 h内补救镇痛情况和恶心呕吐、皮肤瘙痒、呼吸抑制等不良反应发生情况。
结果 与R组比较，A组术中低血压发生率明显降低（P＜0.05），术后30、60 min无痛发生率明显升高（P＜0.05），轻度疼痛和中度疼痛发生率明显降低（P＜0.05），苏醒时间明显延长（P＜0.05）。两组术后24 h内补救镇痛差异无统计学意义。两组术后恶心呕吐、皮肤瘙痒、呼吸抑制发生率差异无统计学意义。
结论 在鼻内镜手术中TIVA应用阿芬太尼对术后镇痛的效果明显优于瑞芬太尼，且围术期不良反应发生率明显低于瑞芬太尼，阿芬太尼的苏醒时间略长于瑞芬太尼。 |
| 英文摘要: |
Objective To compare the effect of postoperative between total intravenous anesthesia (TIVA) use of alfentanil and remifentanil undergoing endoscopic sinus surgery.
Methods A total of 130 and thirty patients scheduled for endoscopic sinus surgery, 62 males and 68 females, aged 18-64 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups: alfentanil group (group A) and remifentanil group (group R). Midazolam 0.02 mg/kg, propofol target-controlled infusion (TCI) 3 μg/ml, alfentanil 20 μg/kg, and rocuronium 0.6 mg/kg were injected intravenously in group A, and target-controlled infusion of propofol combined with alfentanil was used to maintain anesthesia. Midazolam 0.02 mg/kg, propofol TCI 3 μg/ml, remifentanil 1 μg/kg, and rocuronium 0.6 mg/kg were injected intravenously in group R, and target-controlled infusion of propofol combined with remifentanil was used to maintain anesthesia. The number of intraoperative hemodynamic adverse reactions such as hypertension, tachycardia, hypotension, bradycardia during operation, and pain degree at 30 minutes, 60 minutes, 24 hours after operation, extubation time, and rescue analgesia and adverse reactions such as nausea and vomiting, skin pruritus, respiratory depression within 24 hours after operation were recorded.
Results Compared with group R, the incidence of intraoperative hypotension in group A was significantly lower (P < 0.05), the incidence of painless in group A 30 and 60 minutes after operation was significantly higher (P < 0.05), the incidence of mild and moderate pain was significantly decreased (P < 0.05), and the recovery time was significantly prolonged (P < 0.05). There was no significant difference in rescue analgesia within 24 hours after operation. There were no significant differences in the incidence of postoperative nausea and vomiting, postoperative skin pruritus, and respiratory depression between the two groups.
Conclusion In endoscopic sinus surgery, the effect of total intravenous anesthesia with alfentanil on postoperative analgesia is better than that of remifentanil, and the incidence of perioperative and postoperative adverse reactions in alfentanil is lower than that of remifentanil, while the recovery time of alfentanil is slightly longer than that of remifentanil. |
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