Objective To systematically review the clinical effectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Methods Databases including The Cochrane Library (Issue 3, 2013), the database of the Cochrane Anesthesia Group, MEDLINE, EMbase, PubMed, Ovid, Springer, CNKI, VIP and WanFang Data were electronically searched from inception to May 2013 for the randomized controlled trials (RCTs) of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirteen trials involving 647 patients were finally included. The results of meta-analysis showed that: a) for hemodynamic changes, MAP decreased in the remifentanil-propofol group after induction and decreased 5 minutes after intubation, but no significant difference was found between the two groups; the two groups were alike in MAP changes during craniotomy and extubation, and in HR changes after induction, 5 minutes after intubation, during craniotomy and extubation, with no significant difference. b) The result of intra-operative wake-up test showed that, there was no significant difference in the sedative effect and the time of awaking between the two groups. c) For emergence time and extubation time, compared with the sufentanil-propofol group, emergence time and extubation time were significantly shorter than those in the remifentanil-propofol group. d) For side effects, there was no significant difference in side effects (such as post-operative nausea, vomiting, respiratory depression, restlessness, chills and hypotension) between the two groups. And e) for post-operative pain, compared with the remifentanil-propofol group, post-operative 1-h and 2-h VAS were lower and the number of who need additional analgesic drugs within 24 h after operation was less in the sufentanil-propofol group, with significant differences. Both groups used the similar dosage of propofol with no significant difference. Conclusion Compared with the remifentanil-propofol group, hemodynamics changes in the sufentanil-propofol group is steadier after induction and during intubation. Patients in the sufentanil-propofol group are better in postoperative awakening quality. But they are alike in the incidence of side effects and propofol dosage.
目的:比较瑞芬太尼联合异丙酚或依托咪酯全麻在腹腔镜妇科手术中的临床效果。方法:择期腹腔镜妇科手术80例,随机分成瑞芬太尼异丙酚组(RP组)和瑞芬太尼依托咪酯组(RE组),各40例。两组全麻诱导用药相同,维持麻醉RP组采用瑞芬太尼联合异丙酚、RE组采用瑞芬太尼联合依托咪酯。记录基础值、诱导后、插管后1 min、3 min、气腹时、气腹后10、20、30、40 min的动脉收缩压(SBP)、舒张压(DBP)、心率(HR);记录停药至自主呼吸恢复、睁眼、拔除气管导管、恢复定向能力的时间;记录清醒即刻及清醒后1、2、4、8、12、16、20、24 h患者疼痛程度,采用VAS评分;记录24 h内不良反应发生情况。 结果: 两组SBP、DBP均在诱导后明显低于基础值(Plt;001), 插管后恢复,气腹开始后趋于平稳;两组HR均在诱导后减慢(Plt;001),插管后及气腹开始时恢复。RP组自主呼吸恢复、呼之能睁眼、拔除气管导管及恢复定向能力的时间均明显短于RE组(Plt;001)。麻醉清醒即刻、清醒后1、2、4、8 h VAS评分RE组明显低于RP组(Plt;005),12、16、20、24 h VAS评分两组比较无显著性差异(Pgt;005)。术后发生恶心呕吐患者数RP组明显减少(Plt;005)。 结论:全麻行腹腔镜妇科手术时,瑞芬太尼联合异丙酚或依托咪酯都能缓解气腹及手术引起的血流动力学变化,瑞芬太尼联合异丙酚术后苏醒快且能明显降低术后恶心呕吐的发生率,但术后疼痛较为严重。
目的:比较七氟醚吸入麻醉和丙泊酚、瑞芬太尼静脉麻醉用于小儿手术的临床效果。方法:100例1～8岁的患儿随机分为丙泊酚、瑞芬太尼组(A组)与七氟醚吸入组(B组）。麻醉诱导后,A组持续输注丙泊酚和瑞芬太尼维持麻醉,B组吸入七氟醚维持麻醉。术中根据生命体征调整丙泊酚、瑞芬太尼的输注速度及七氟醚的吸入浓度,记录术中循环变化、术后麻醉恢复情况。结果:与B组相比,A组术中MAP下降明显(Plt;005)。结论:与A组相比,B组术中生命体征控制平稳;术后清醒迅速、完全、平稳,拔管时间无明显差异。
目的:探讨甲状腺手术中氟比洛芬酯对丙泊酚—瑞芬太尼麻醉效果的影响。方法:将210例择期丙泊酚—瑞芬太尼麻醉下行甲状腺手术患者随机分为对照组和氟比洛芬酯组,每组105例。于切皮前30 min,对照组静脉注入等量生理盐水10mL,氟比洛芬酯组经静脉注入氟比洛芬酯注射液100 mg。分别记录患者麻醉前10 min (T0)、切皮时(T1)、切皮后10 min (T2)、切除腺体时 (T3)以及拔管时 (T4) 的血流动力学 (SBP、DBP、HR) 的变化以及术后口述描述评分(VRS)。结果:与对照组比较, 氟比洛芬酯组T14时SP、DP均降低,两组差别有统计学意义(Plt;005)。氟比洛芬酯组离开手术室时无痛率明显高于对照组,两组差别有统计学意义(Plt;005)。结论:氟比洛芬酯对丙泊酚—瑞芬太尼麻醉下行甲状腺手术患者血流动力学影响小,且减轻术后疼痛,术后恢复更为舒适。
目的 探讨丙泊酚复合瑞芬太尼在患者清醒状态下实施无痛肠镜法的可行性。 方法 2011年7月－2012年7月，将160例行无痛肠镜检查的患者随机分为两组: A组用芬太尼复合丙泊酚麻醉,其中男38例，女42例，平均年龄（48 ± 16）岁，平均体重（53.37 ± 9.5）kg；B组以阿托品0.25～0.5 mg缓慢静脉注射，继而以瑞芬太尼+丙泊酚复合液缓慢静脉滴注，使患者保持清醒状态，其中男43例，女37例，平均年龄（49 ± 15）岁，平均体重（54.26 ± 8.3）kg。观察两组患者检查中血压、心率、呼吸、血氧饱和度变化，检查中体动反应，检查后苏醒时间、定向力恢复、行走时间、离室时间，以及对检查过程的记忆情况。 结果 两组患者均能顺利完成检查，术中记忆率均低，差异无统计学意义（P＞0.05）。A组患者循环改变、心动过缓、低氧血症、以及体动反应明显高于B组（P＜0.05），B组患者苏醒时间、定向力恢复、行走时间、离室时间，明显短于A组（P＜0.05）。 结论 瑞芬太尼-丙泊酚复合液伍用阿托品能够安全应用于患者清醒状态下实施的无痛肠镜检查，具有良好的临床推广价值。
目的 探讨丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤的保护作用以及作用机制。 方法 2009年6月－2011年12月选择择期需阻断肝门的肝脏手术患者40例，随机分为丙泊酚-瑞芬太尼组（P组）和异氟醚组（I组），每组20例。在术前（T0）和肝门阻断开放后30 min（T1）、60 min（T2）、6 h（T3）、24 h（T4）、72 h（T5）分别抽取动脉血，测定天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）和肿瘤坏死因子α（TNF-α）的含量。 结果 两组AST、ALT、TNF-α较术前均有增高，差异有统计学意义（P＜0.05）；P组增高幅度明显低于I组，差异有统计学意义（P＜0.05）。 结论 丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤具有保护作用，抑制TNF-α的产生可能为其作用机制之一。
目的 系统评价瑞芬太尼用于全身麻醉下剖宫产时对新生儿的影响。 方法 检索Cochrane Library、PubMed、OVID、EMbase、CNKI、万方等中外数据库，收集1990年－2012年关于瑞芬太尼用于全身麻醉下剖宫产的临床随机对照研究。按Cochrane系统评价方法评估文献质量，用Revman 5.1软件对提取的数据进行Meta分析。 结果 共纳入10项研究，包括342例产妇。与空白对照组相比，瑞芬太尼降低新生儿1 min Apgar评分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生时脐动脉pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生时窒息发生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；当诱导剂量为1.0～1.5 μg/kg时，对5 min Apgar评分无影响[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。 结论 瑞芬太尼用于全身麻醉剖宫产可减轻新生儿酸中毒，但是会对新生儿产生一过性的呼吸抑制。
【摘要】 目的 确定在不同浓度七氟醚复合瑞芬太尼诱导无肌松气管插管时瑞芬太尼的半数有效量（ED50）。 方法 2009年7月-2009年11月择期手术患者60例，ASA I~II，年龄20~59岁，按照入室的顺序随机分为Ⅰ组（2%七氟醚组）和Ⅱ组（3%七氟醚组），预冲8%七氟醚诱导，眼睑反射消失后，调节七氟醚呼气末浓度分别维持在2%或3%，同时按照序贯法注入瑞芬太尼，瑞芬太尼注射90 s后气管插管。记录麻醉诱导前、患者意识消失时、插管前1 min、插管后1 min及插管后3 min心率、平均动脉压的变化。 结果 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量（ED50）及其相对应的95%可信区间分别为0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。 结论 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量及其相对应的95%可信区间分别为0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。【Abstract】 Objective To determine the half effective dose (ED50) of remifentanil dose for tracheal intubation without neuromuscular relaxant in adult when combined with different concentration of sevoflurane. Methods Sixty ASA Ⅰ to Ⅱ adult aged 20 to 59 years old, scheduled for elective surgery under general anesthesia were enrolled in this study between July 2009 to November 2009. All patients were ranged randomly into Group Ⅰ (2% sevoflurane) and Group Ⅱ (3% sevoflurane).Anesthesia was induced with 8% sevoflurane in 100% oxygenat at 6 L/min.After the loss of eyelash reflex, remifentanil was injected over 30 s, end-tidal sevoflurane concentration 2% or 3% was maitained. The dose of remifentanil was determined by up-and-down method. In 90 s after the end of bolus administration of remifentanil, the trachea was intubated. Mean blood pressure and heart rate were recorded at anaesthetic induction, the loss of eyelash reflex, before, in 1 min and 3 min after intubation. Results ED50 values (95% confidence intervals)of remifentanil for tracheal intubation during 2% and 3% sevoflurane induction without neuromuscular relaxant were 0.585 μg/kg and 0.533 - 0.626 μg/kg, and 0.492 μg/kg and 0.451 - 0.572 μg/kg, respectively. Conclusion ED50 values (95% confidence intervals)of remifentanil for tracheal intubation 2% and 3% sevoflurane induction without neuromuscular relaxant are 0.585 μg/kg (0.533 - 0.626 μg/kg) and 0.492 μg/kg (0.451 - 0.572 μg/kg), respectively.
【摘要】 目的 观察在腹腔镜胆囊切除术中，氯胺酮超前镇痛对瑞芬太尼麻醉后急性疼痛的影响。 方法 2009年10月-2010年1月，将择期行腹腔镜胆囊切除术患者90例，随机分为对照组（C组）、氯胺酮超前镇痛组（K组）、氯胺酮术毕镇痛组（K1组），每组30例。所有患者均采用瑞芬太尼复合丙泊酚静脉麻醉，K组在切皮前静脉给予氯胺酮0.5 mg/kg，K1组在关腹前静脉给予氯胺酮0.5 mg/kg，C组不给予任何药物。记录术毕患者麻醉恢复情况，各时间点疼痛程度。 结果 K组、K1组躁动发生率均明显低于C组（Plt;0.05）；术后2、4、8、24 h，K组VAS评分及镇痛药使用率明显低于C组和K1组（Plt;0.05）。 结论 氯胺酮超前镇痛能明显降低瑞芬太尼术后疼痛，并且不增加并发症发生率。【Abstract】 Objective To evaluate the preemptive analgesia of ketamine on remifentanil induced acute postoperative pain after laparoscopic cholecystectomy. Methods Ninty patients scheduled for laparoscopic cholecystectomy between october 2009 to Jannary 2010 were randomly assigned to three groups (n=30). Group K was administrated with 0. 5 mg/kg ketamine intravenously before skin incision, and Group K1 were administrated with 0. 5 mg/kg ketamine intravenously before abdominal closure, while Group C received nothing. The recovery and the side effects were recorded, the VAS at two, four, eight and 24 hours after surgery, and the use of anodyne were recorded. Results The incidence of restlessness in Groups K and K1 was remarkably lower than that of Group C (Plt;0. 05). The analgesic effects two, four, eight and 24 hours after surgery were obviously better in group K than those of Group C and Group K1 (Plt;0. 05). Conclusion Ketamine can produce preemptive analgesia to relieve remifentanil-induced acute pain, and it would not increase incidence of side effects.