芬太尼或瑞芬太尼复合异氟烷用于肾移植麻醉的比较【摘要】目的终末期肾功能衰竭的病人对药物摄取、分布与清除存在很大差异，增加了围术期麻醉处理的复杂性。盐酸瑞芬太尼是一种新型的mu受体激动剂，其中含有酯键，主要经血液和组织中非特异性酯酶水解代谢，不依赖于肝、肾功能，它起效快，时效半衰期短且与用药总量和输注时间无关，可
安全用于肾功能不全的患者。本研究观察瑞芬太尼用于肾移植麻醉的诱导和术后苏醒过程，并与芬太尼对照，比较异氟烷复合芬太尼或瑞芬太尼用于肾移植麻醉的诱导和术后苏醒过程，评估瑞芬太尼用于肾移植麻醉的安全性和有效性。方法终末期肾功能衰竭行肾移植术的患者32例随机分为芬太尼组和瑞芬太尼组，每组16例。观察麻醉诱导、气管插管时及术中血流动力学变化；术毕停药后病人自主呼吸恢复时间，呼之睁眼时间，拔管时间，定向力恢复时间；观察病人拔管后即刻、拔管后30min、1h、3h和24h的意识状态（os），认识功能测试（mmse）；观察术后不良反应的发生率等。结果在麻醉诱导期间，瑞芬太尼组患者血流动力学变化幅度显著小于芬太尼组（p＜0.05＝。瑞芬太尼组病人自主呼吸恢复时间，呼之睁眼时间，拔管时间，定向力恢复时间均早于芬太尼组（p＜0.05＝。瑞芬太尼组拔管后即刻、拔管后30min、1h、3h的os及mmse评分均高于芬太尼组（p＜0.05＝。在不良反应方面两组无显著性差异。结论临床观察表明，瑞芬太尼复合异氟烷麻醉应用于肾移植病人是一种安全、有效的麻醉方法，其麻醉诱导更加平稳，可缩短拔管时间，且患者苏醒质量更高，有利于病人恢复。【关键词】瑞芬太尼；芬太尼；肾移植；麻醉parisonofanesthesiaforkidneytransplantsurgeryusingfentanylorremifentanilwithisofluraneinhalationanesthesiahugang,liyimai,wudi,etal.departmentofanesthesiology,renminhospitalofwuhanuniversity,wuhan430060,china.【abstract】objectivetoparethehemodynamicsduringinductionandmaintenanceofanesthesindrecoveryprofilesusingfentanylorremifentanilwithisofluraneinhalationanesthesiainkidneytransplantsurgery.methods32patientsundergoingrenaransplantationwererandomlydividedintofentanylgrouporremifentanylgroupwith16casesineachgroup.anesthesiawasinducedwithpropofol(2mg/kg)andeitherfentanyl(2.5mug/kg)orremifentanil(2mug/kg),andwasmaintainedwithisofluraneinhalationanesthesindacontinuousinfusionofeitherfentanyl(0.03mugbullkg1bullmin1)orremifentanil(0.2mugbullkg1bullmin1).thehemodynamicchangesofpatientsatdifferentstagesofanestheticandsurgicalproceduresandrecoveryprofileswerepared.resusthehemodynamicchangesofpatientsatdifferentstagesofanestheticandsurgicalproceduresintheremifentanilgroupweresignificantlysmallerthanthoseinthefentanylgroup(p＜0.05＝.timesfromstoppingadministrationofanestheticsuntilfullspontaneousrespiration,eyeopening,etuibation,andorientationweresignificantlylessintheremifentanilgroupthaninthefentanylgroup(p＜0.05＝.theobserversassessmentofalertness/sedation(os)scoresandtheminimentalstatesscores(mmse)attrachealetubation,30min,1hand3hafteretubationwerehigherintheremifentanilgroupthaninthefentanylgroup(p＜0.05＝.therewasnosignificantlydifferencebetweenthetwogroupsintheaspectofadversereactions.conclusionremifentanilwithisofluraneinhalationanesthesiainkidneytransplantsurgeryisassociatedwithbetterhemodynamicstabilityandrecoveryprofileparedwithfentanyl.【keywords】remifentanil；fentanyl；renaransplantation；anesthesia