摘要
目的评价靶控输注瑞芬太尼用于局麻手术的镇静和镇痛效果。方法 60例ASA Ⅰ～Ⅱ级择期乳腺肿物切除术女性患者,于局部浸润麻醉前5min靶控输注瑞芬太尼,初始血浆靶浓度为2.0ng/ml,术中根据临床体征和监测参数调整靶浓度,每次递增或递减0.3ng/ml,直至RamSay镇静评分2～4分,或口述镇痛评分(VPS)0～1分,手术结束前5min停药。于局部浸润麻醉前(T_0)、局部浸润麻醉时(T_1)、手术切皮时(T_2)、游离肿物时(T_3)及术毕(T_4)记录收缩压(SBP)、平均动脉压(MAP)、心率(HR)、指脉氧饱和度(SpO_2)、RamSay评分、VPS评分及瑞芬太尼血浆靶浓度;记录呼吸抑制、肌肉僵硬、恶心呕吐及皮肤瘙痒等不良反应的发生情况;询问患者对本次麻醉的满意度;计算瑞芬太尼平均血浆靶浓度。结果各时点SBP、MAP、SpO_2的差异无统计学意义(P>0.05);T_2、T_3时HR降低(P<0.05);RamSay评分T_3时升高,T_4时下降(P<0.05),RamSay评分均为2～4分;VPS评分T_2时开始升高,T_3时达高峰,T_4时下降(P<0.05),VPS评分均为0～1分;无一例发生不良反应,患者满意率100%;瑞芬太尼最终血浆靶浓度范围为1.8～4.2ng/ml,平均血浆靶浓度为2.8±0.8ng/ml。结论靶控输注瑞芬太尼用于局麻手术的镇静和镇痛效果良好,且无明显不良反应。
Objective To evaluate the mitigation and analgesia effect of Remifentanil target controlled infusion in local anesthesia operation. Methods 60 ASA Ⅰ - Ⅱ grade female patients undergoing date - selected lacteal gland adenoncus excision were target - controlled infused by Remifentanil 5 minutes before local infiltration anesthesia with the incipient hematoplasma target level of 2.0ng/ml. We adjusted the target level by means of increase or decrease 0.3ng/ml progressively according to clinical signs and monitored parameters during operation, until the RamSay mitigation score was 2 - 4 or Verbal Pain Score （VPS） was 0 - 1. We withdrew the drug 5 minutes before the end of operation. Systolic pressure（SBP） , mean arterial pressure （MAP） , heart Rate （HR） , pulse oxygen Saturation （ SpO2 ） , ramSay score, VPS score and hematoplasma target level of Remifentanil were noted down respectively at the time of before local infiltration anesthesia（ T0 ） , during local infiltration anesthesia（ T1 ） , skin cutting in the operation （T2 ） , adenoncus liberation（ T3 ） and the end of operation（T4 ）. The occurrence of adverse effect such as respiratory depression, muscle stiffness, nausea and vomiting, as well as itch of skin was also recorded. Patients were inquired about the extent of satisfaction of the anesthesia. Mean hematoplasma target level was noted down. Results The difference of SBP, MAP and SpO2 between each time point had no statistical significance（P 〉 0.05 ）. HR decreased at the time of T2 and T3 （ P 〈 0.05 ）. RamSay score increased at the time of Z3 and decreased at the time of T4 （ P 〈 0.05 ）. The mean RamSay score was 2 - 4. VPS score began to increase at the time of T2 , and reached the peak at the time of T3 , and decreased at the time of T4. The mean VPS score was 0 - 1. No adverse reaction occurred, and the ratio of patients satisfaction was 100% . The final hematoplasma lev- el ranged from 1.8 to 4.2ng/ml, with the mean hematoplasma level being 2.8 ± 0. 8ng/ml. Conclusion Target controlled infusion of Remifentanil has good mitigation and anesthesia effect during local anesthesia operation and has no significant adverse effects.
出处
《医学研究杂志》
2009年第10期47-49,66,共4页
Journal of Medical Research
关键词
瑞芬太尼
镇静
镇痛
靶控输注
Remifentanil
Mitigation
Anesthesia
Target controlled infusion
