赵立　梁永新

摘 要：目的 探討靶控输注瑞芬太尼联合丙泊酚应用于食道异物取出术的临床麻醉效果。方法 将2017年6月～12月在我院行食道异物取出术的60例患者，随机分为瑞芬太尼组（RF组）和舒芬太尼组（SF组），每组30例。RF组应用TCI靶控输注瑞芬太尼联合丙泊酚和维库溴铵进行气管插管全麻；SF组应用TCI靶控输注舒芬太尼联合丙泊酚和维库溴铵进行气管插管全麻。观察两组患者诱导前和取异物时的MAP、HR、SpO2，气管拔管时间，不良反应发生例数，丙泊酚总使用剂量，术后30 min及1 h的疼痛语言分级评分（VRS）和改良的OAA/S评分。结果 RF组在取异物时的MAP为（84.5±5.0）mmHg，低于SF组的（93.5±5.4）mmHg，差异有统计学意义（P<0.05）。RF组在取异物时的HR为（73.0±8.1）次/min，低于SF组的（81.3±7.1）次/min，差异有统计学意义（P<0.05）。RF组的气管拔管时间为（16.0±3.6）min，少于SF组的（19.0±4.0）min，差异有统计学意义（P<0.05）。RF组在术毕拔管后的不良反应例数、丙泊酚总使用剂量以及术后早期清醒评分等方面优于SF组，差异有统计学意义（P<0.05）。结论 瑞芬太尼作为镇痛药物应用于食道异物取出术，可更好的维持循环系统的稳定性，提高麻醉效率及安全性。

关键词：瑞芬太尼；舒芬太尼；食道异物取出术；麻醉

中图分类号：R768.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.11.028

文章编号：1006-1959（2018）11-0093-03

Analysis of Anesthetic Effect of Remifentanil Combined with Propofol for Removal of Esophageal Foreign Body

ZHAO Li1，2，LIANG Yong-xin3

（1.Qingdao University，Qingdao 266000，Shandong，China；

2.Chengwu County People's Hospital，Chengwu 274200，Shandong，China；

3.Department of Anesthesiology，Affiliated Hospital of Qingdao University，Qingdao 266000，Shandong，China）

Abstract：Objective To investigate the anesthetic effect of target controlled infusion of remifentanil combined with propofol in esophageal foreign body removal.Methods From June to December 2017，60 patients undergoing esophageal foreign body removal were randomly divided into remifentanil group（RF group）and sufentanil group（SF group）with 30 cases in each.In RF group，TCI target controlled infusion of remifentanil combined with propofol and vecuronium bromide was used for tracheal intubation general anesthesia was performed；In SF group，TCI target-controlled infusion of sufentanil combined with propofol and vecuronium bromide was used for tracheal intubation general anesthesia.Before induction and at the time of foreign body extraction，MAP，HR，SpO2，tracheal extubation time，number of adverse reactions，total dose of propofol，pain language score（VRS）and improved OAA/S score at 30min and 1h after operation were observed in both groups.Results The MAP of the RF group was（84.5±5.0）mmHg，which was lower than that in SF group （93.5±5.4）mmHg，the difference was statistically significant（P<0.05）.The HR of the RF group was （73.0±8.1）times/min， which was lower than that in SF group（81.3±7.1）times/min，the difference was statistically significant（P<0.05）.The tracheal extubation time in RF group was（16.0±3.6）min，which was less than that in SF group（19.0±4.0）min，the difference was statistically significant（P<0.05）.The number of adverse reactions after extubation，the total dosage of propofol and the early postoperative sobriety score in RF group were better than those in SF group，the difference was statistically significant（P<0.05）.Conclusion Remifentanil as an analgesic can improve the stability of circulatory system and improve the efficiency and safety of anesthesia.

Key words：Remifentanil；Sufentanil；Esophageal foreign body removal；Anesthesia

食道异物取出术是五官科最为常见的手术，其具有手术时间短，术后疼痛刺激小，恢复快等特点。良好的麻醉可以有效的减少心血管反应及并发症的发生，不仅可以提高手术效果，而且可以增加患者的舒适感。瑞芬太尼是一种新型阿片类镇痛药物，其起效快、镇痛药效强、作用时间短，为临床理想的麻醉药物[1]。为验证瑞芬太尼联合丙泊酚应用于食道异物取出术的临床麻醉效果，笔者对2017年6月～12月在本院行食道异物取出术的60例患者采用靶控输注瑞芬太尼与舒芬太尼分别联合丙泊酚进行麻醉效果比较，现总结如下。

1资料与方法

1.1一般资料 选取2017年6月～2017年12月在成武县人民医院行食道异物取出术的60例患者，采用随机数字表法分为瑞芬太尼组（RF组）和舒芬太尼组（SF组），每组30例。……