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目的:观察比较瑞芬太尼和芬太尼在老年颌面术中全凭静脉麻醉的效果。方法:选择期行老年颌面术50例,随机分为瑞芬太尼组和芬太尼组各25例。观察比较两组诱导前(T0)、插管前(T1)、插管后1 min(T2)、5 min(T3)、手术开始后10 min(T4)和60min(T5)节点的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR)变化;麻醉苏醒期呼吸道保护性反射恢复时间、睁眼时间、拔管时间和苏醒后患者的安静程度。结果:瑞芬太尼组在T1、T2和T4节点SBP、DBP、MAP和HR均显著低于芬太尼组(P<0.05或P<0.01);麻醉苏醒期呼吸道保护性反射恢复时间、睁眼时间和拔除气管导管时间均显著短于芬太尼组(P<0.01),但瑞芬太尼组有24例出现躁动,而芬太尼组仅2例。结论:瑞芬太尼更适合老年颌面术中全凭静脉麻醉,但须适时给予镇痛。
Objective: To observe the effect of remifentanil and fentanyl on total intravenous anesthesia in elderly maxillofacial surgery. Methods: 50 elderly patients undergoing maxillofacial surgery were randomly divided into remifentanil group and 25 fentanyl group. The systolic blood pressure (T), pre-intubation (T1), 1 min (T2), 5 min (T3) after intubation, 10 min (T4) and 60 min SBP, DBP, MAP and HR; recovery time of protective reflex of airway during anesthesia recovery, eyes open time, extubation time and patient’s recovery after recovery. Results: The SBP, DBP, MAP and HR in remifentanil group at T1, T2 and T4 were significantly lower than those in fentanyl group (P <0.05 or P <0.01); resuscitation time of respiratory protective reflex was higher in remifentanil group Eye time and catheter removal were significantly shorter in the fentanyl group than in the fentanyl group (P <0.01), but 24 in the remifentanil group had agitation and only 2 in the fentanyl group. Conclusion: Remifentanil is more suitable for general anesthesia in elderly maxillofacial surgery, but analgesia should be given timely.