异丙酚复合小剂量芬太尼对心脏术后早期拔管的影响(1)
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2010年2月1日
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【摘要】目的:观察异丙酚复合小剂量芬太尼对心脏术后早期拔管的影响。方法:60 例择期房室缺修补手术病人,随机分成芬太尼组(F 组)和异丙酚组(P组)。F 组使用中剂量芬太尼(30~35μg/kg)。P 组使用小剂量芬太尼(15~20μg/kg)及持续静脉泵注异丙酚(4~6mg/(kg·h))。两组维库溴胺及咪唑安定用法相同。结果:两组病人血流动力学参数变化差异无显著性(P>0.05),P 组拔管的时间明显短于F 组(P<0.05),术后呕吐发生率呈减低趋势。结论:房室缺修补术患者术中,异丙酚4~6mg/(kg·h)持续静脉泵注复合小剂量芬太尼维持麻醉有利于术后早期拔管。
【关键词】异丙酚; 芬太尼; 血流动力学; 麻醉学
【中图分类号】R614.2 【文献标识码】B 【文章编号】1008-6455(2010)08-0032-02
【Abstract】Objective:Toobservethe effects of propofol with a small dose of fentanyl on early extubation in patients undergoing cardiac surgery.Methods:Sixty patients undergoing elective antrium and ventricle septum deficiency(ASD,VSD) surgery wererandomly put into two groups:fentanyl group (F group) and propofol group (P group). The total dose of fentalyl was 30~35μg/kg in the F group. Thetotal dose of fentanyl was 15~20μg/kg in the Pgroup; propofol was given at the rate of4~6mg/(kg·h) intravenously in the P group. The use of vecuronium and midazolum in the two groups was the same.ResultsThere was no significant difference in hemodynamic changes between the two groups (P>0.05). The extubation time of the P group was significantly shorter than that of the F group (P<0.05). The rate of post-operation vomit occurrence was decreased.Conclusion It is useful for early extubation that propofol is given at the rate of 4~6mg/(kg·h)intravenously combiner with a small dose of fentanly in patients undergoing ASD and VSD surgery.
【Key words】Propofol;Fentanyl;Hemodynamic; Anesthesiology
芬太尼因其对血流动力学影响轻微的特点而在心脏麻醉中占有主导地位。但大剂量应用芬太尼时,可出现遗忘呼吸,术后将延长机械通气的时间。而根据美国麻醉医师协会(ASA)分Ⅱ~Ⅲ 级房、室缺修补术患者术后无需长时间机械通气。近年来,快通道心脏麻醉越来越受到关注。大量研究表明绝大多数心脏手术后能够早期拔管,具有可行性和安全性,早期拔管能缩短病人在FE; 的滞留时间,改善病人的预后和降低医疗费用[1]。异丙酚具有起效快、苏醒快、静脉持续泵注对血流动力学影响轻微等优点,在临床中得到广泛应用。本文旨在观察异丙酚对无肺动脉高压的房、室缺修补术患者术后早期拔管的影响。
1 资料与方法
1.1 病例选择:选择房、室缺修补术患者60 例,随机分为芬太尼组(F 组,n=30)和异丙酚组(P 组,n=30)。F组男女各15例,其中房缺16例,室缺14例,年龄(6.30 ±2.25)岁,体重(16.04±4.21)kg。P组男13例,女17例,其中房、室缺各15例,年龄(6.10 ±1.70)岁,体重(15.96±4.10)kg。所有病人ASA分级为Ⅱ~Ⅲ级,术前射血分数(EF)均>50%,无肺动脉高压、无严重心功能不全及其他脏器功能异常。
1.2 麻醉方法:术前30min (肌注吗啡0.2mg·kg-1,东莨菪碱0006mg·kg-1,两组麻醉诱导方法一致。静脉注射咪唑安定0 ......
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