瑞芬太尼用于老年人麻醉的临床研究进展

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3. 3　在胸部及上腹部手术中的应用　全身麻醉下行胸部及上腹部手术对高龄患者来说危险性极大,手术时间长,创伤大,应激反应强烈,术后并发症多。选择合适的麻醉方法和麻醉用药是保证高龄患者平稳渡过围术期,降低病死率的关键。国内研究发现,老年患者的胸部及上腹部手术静吸全身麻醉中,应用瑞芬太尼静脉滴注维持麻醉深度与使用异丙酚间断静脉注射给药,都具有起效迅速、麻醉加深快、术后苏醒早、苏醒期无烦躁等优点,但异丙酚间断静脉注射更易引起血流动力学的不稳定^{[ 19} ^]。王竹梅等^{[ 18 ]}报道,异丙酚血浆靶浓度2μg/mL复合瑞芬太尼2μg/L血浆靶浓度麻醉诱导用于腹腔镜胆囊切除术老年患者时,麻醉诱导平稳,术中根据血压和心率等调整瑞芬太尼血浆靶浓度,术中循环稳定,麻醉效果满意,术后呼吸恢复快,苏醒迅速。

3. 4　在门诊手术中的应用　瑞芬太尼麻醉术后患者苏醒快,定向力恢复快,神经认知测试优于芬太尼^{[ 19 ]} 。特别适用于门诊麻醉手术, 尤其适用于老年患者门诊手术麻醉。Agnew等^{[ 20 ]}报道,瑞芬太尼用于门诊手术及内镜检查可使患者镇痛完善,神经运动能力恢复更快更完全。静脉微量泵瑞芬太尼复合异丙酚麻醉效果确切、安全,是老年患者门诊检查的麻醉选择方法之一,但术中应注意瑞芬太尼的给药速度,加强呼吸监护与管理。

综上所述,瑞芬太尼具有起效快、作用时间短、消除快、没有特殊的不良反应的特点,作为一种比较理想的麻醉性镇痛药,诱导迅速、有效抑制气管插管反应、术中血流动力学相对稳定、对强烈手术刺激应激反应小、术后苏醒质量更优、并发症少,应用范围不断扩大,在临床麻醉中的应用已经有了一定程度的发展,但在老年人临床麻醉的推广应用还需要更深更广的研究,新的应用领域也有待进一步拓展。

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