舒芬太尼复合异丙酚在急性心肌梗死镇痛中的应用研究

发布时间：2019-01-03 11:28

【摘要】：目的探讨舒芬太尼复合异丙酚麻醉在急性心肌梗死镇痛中的应用效果。方法按随机数字表法将118例急性心肌梗死镇痛患者分为舒芬太尼组与瑞芬太尼组,每组59例。舒芬太尼、瑞芬太尼初始靶效应室浓度分别为0.25、2ng/ml,均复合初始血浆靶浓度为2μg/ml的异丙酚,每2min增加0.5μg/ml,直至患者意识消失。比较两组患者在麻醉诱导前(T0)、插管前(T1)、插管后即刻(T2)、插管后2min(T3)、术毕(T4)和拔管(T5)时的血流动力学变化以及两组麻醉情况、苏醒时间、术后镇痛效果、并发症发生情况。结果两组收缩压(SBP)和舒张压(DBP)于T0 T2时逐渐下降,T2 T5时逐渐上升,心率(HR)于T0 T1时逐渐下降,T1 T5时逐渐上升,但瑞芬太尼组波动较舒芬太尼组更为明显。两组SBP和DBP于T1 T5时有显著性差异,HR于T1、T2和T5时有显著性差异(P0.05)。两组麻醉时间、意识消失时间、意识消失时异丙酚剂量和异丙酚总剂量无显著性差异(P0.05);舒芬太尼组自主呼吸恢复时间、呼之睁眼时间、拔管时间和定向力恢复时间均明显长于瑞芬太尼组(P0.05),VAS评分显著高于瑞芬太尼组,镇痛药使用率及并发症发生率明显低于瑞芬太尼组(P0.05)。OAA/S评分两组间比较差异无统计学意义(P0.05)。结论与瑞芬太尼相比,舒芬太尼复合异丙酚麻醉用于急性心肌梗死镇痛患者,血流动力学更加平稳,术后苏醒质量更优,并发症更少,值得临床推广应用。
[Abstract]:Objective to investigate the analgesic effect of sufentanil combined with propofol in acute myocardial infarction. Methods 118 patients with acute myocardial infarction were randomly divided into sufentanil group and remifentanil group with 59 cases in each group. Sufentanil and remifentanil were combined with propofol with initial plasma target concentration of 2 渭 g/ml, which were 0.25g / ml and 0.25g / ml, respectively, and increased by 0.5 渭 g / ml per 2min until the patient's consciousness disappeared. The hemodynamic changes before anesthesia induction (T0), before intubation (T1), immediately after intubation (T2), after intubation (T3), after operation (T4) and extubation (T5) were compared between the two groups. Postoperative analgesia and complications. Results systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased gradually at T _ 0 T _ 2, increased at T _ 2 T _ 5, decreased at T _ 0 T _ 1, and increased at T _ 1 / T _ 5, but the fluctuation was more obvious in remifentanil group than in sufentanil group. There was significant difference between SBP and DBP at T1 / T5 and HR at T1 / T5 (P0.05). There was no significant difference in anesthetic time and total dose of propofol between the two groups when consciousness disappeared (P0.05). The time of spontaneous respiratory recovery, eye opening, extubation and remifentanil group in sufentanil group was significantly longer than that in remifentanil group (P0.05), VAS score was significantly higher than that in remifentanil group. The incidence of analgesics and complications was significantly lower than that of remifentanil group (P0.05). There was no significant difference in OAA/S score between the two groups (P0.05). Conclusion compared with remifentanil, sufentanil combined with propofol anesthesia for acute myocardial infarction analgesia patients, hemodynamics is more stable, postoperative recovery quality is better, fewer complications, worthy of clinical application.
【作者单位】：安徽医科大学第一附属医院急诊科;
【分类号】：R614

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