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神经外科手术中瑞芬太尼或芬太尼联合普鲁泊福的麻醉效果比较

The anesthetic effect of remifentanil or fentanyl combined with propofol during neurosurgery

摘要:

目的 比较瑞芬太尼或芬太尼联合普鲁泊福在神经外科手术中的麻醉效果,以便选择最佳麻醉组合.方法 选取择期行神经外科手术的颅内占位性病变96例,ASA分级Ⅰ~Ⅱ级,按随机数字表法分为对照组(普鲁泊福联合芬太尼组)和试验组(普鲁泊福联合瑞芬太尼组),每组各48例.记录两组普鲁泊福追加量,观察有无呼吸抑制、苏醒期躁动、术后精神障碍等不良反应.分别对其镇痛效果进行评估.结果 试验组和对照组患者拔管后5 min的警觉,镇静评分为5分有20例(41.7%)、4分有24例(50.0%),对照组分别有2例(4.2%)和16例(33.3%),两组比较差异均有统计学意义(P<0.05).试验组苏醒时间、普鲁泊福诱导量、普鲁泊福总用量分别为(3.6±0.8)min、(1.36±0.21)mg/kg、(103.42±9.10)mg.对照组分别为(7.2±1.0)min、(1.76±0.32)mg/kg、(143.82±8.40)mg,两组比较差异均有统计学意义(P<0.05).结论 在神经外科手术室采用普鲁泊福联合瑞芬太尼进行静脉麻醉,起效快、作用时间短、快速苏醒,是理想的麻醉方法.

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Objective To compare and analyze the anesthetic effect of remifentanil or fentanyl combined with propofol during neurosurgery. Methods Ninety-six cases of neurosurgical patients undergoing elective surgery, ASA Ⅰ- Ⅱ grade, were randomly divided into control group (propefol-fentanyl group) and experimental group (propofol-remifentanil group), each 48 cases. Recordsed the additional dosage of the drug and observed whether the respiratory depression, restlessness recovery period, postoperative mental disorders, adverse reactions. The analgesic effects were evaluated. Results In 5 minutes after extubation, the cases in the experimental group and the control group who got 5 in the OAA/S score were respectively 20(41.7%),2(4.2%), there was statistically significant difference between the two groups, and the cases who got 4 in the OAA/S score were respectively 24(50.0%),16(33.3%),there were statistically significant differeneebetwecn the two groups (P<0.05).The cases in the experimental group and the control group who got pain in 0 grade were respectively 48 (100.0%), 44 (91.7%), there was no statistically significant difference between the two groups (P> 0.05). Recovery time of the patients in the experimental group and the control group were respectively (3.6±0.8),(7.2±1.0) mitt, the difference on the recovery time between the two groups was statistically significant (P<0.05). The amount of propefol induction in the experimental group and the control group were respectively (1.36±0.21),(1.76±0.32) mg/kg, the difference between the two groups was statistically significant (P<0.05). The total dosage of propofol in the experimental group and the control group were respectively (103.42±9.10),(143.82±8.40) mg, the total dosage of propofol of the experimental group was significantly lower than that of the control group, the difference between the two groups was statistically significant (P<0.05).Conclusions During the neurosurgical operation, the onset time soon, the role of time is short, fast awake. Propofol combined with remifentanil intravenous anesthesia is the ideal anesthesia.

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