瑞芬太尼分别复合异丙酚和七氟醚麻醉在老年重危患者手术中的应用(2)
有研究报道，七氟醚能够增加患者术后恶心呕吐(PONV)的发生率。Hofer等比较丙泊酚与七氟醚对患者麻醉后恢复的影响。两组在术后90min和24h术后恶心呕吐的发生率分别为7% vs 35%(P[9]。而J. R. Sneyd[11]则认为PONV的发生率仅为15%，七氟醚麻醉和异丙酚麻醉并无差异，H. Yang也提出了相似观点[10]。本研究所得数据为21%和25%分别异丙酚和七氟醚麻醉，由于术后应用了曲马多复合芬太尼进行术后镇痛同时应用昂丹司琼镇吐，所以本数据不能反应真实的麻醉药的术后影响。
瑞芬太尼复合异丙酚麻醉与瑞芬太尼复合七氟醚麻醉在诱导、维持、苏醒恢复以及PONV的发生上均无统计学上的差异。[10]瑞芬太尼分别与以上两种药物的联合应用可以达到一种接近理想的效果，我们可认为两种麻醉方法均可安全、确实有效地用于高龄危重患者。
参考文献
, 百拇医药
[1]余淑珍.刘保江.瑞芬太尼的药理学、临床研究和应用进展[J].国外医学：麻醉学与复苏分册,2004,25(6):356-357
[2] 宁捷,冯燕春,何艺. 瑞芬太尼复合异丙酚静脉全麻在老年病人上腹部手术中的应用[J].右江民族医学院学报，2006，28(3):410-411
[3] Fanelli G, Berti M, Cadsiti A. Fast-track anaesthesia for laparoscopic cholecystectomy: a prospective, randomized, multicentre, blind comparison of desflurane-remifentanil or sevoflurane-remifentanil. Eur J Anaesthesiol, 2006,23: 861-867
[4] Ku AS, Hu Y, Irwin MG, et al. Effect of sevoflurane/nitrous oxide versus propofol anaesthesia on somatosensory evoked potential monitoring of the spinal cord during surgery to correct scoliosis.Br J Anaesth 2002; 88: 5027
, 百拇医药
[5] Lien CA, Hemmings HC, Belmont MR, Abalos A, Hollmann C, Kelly RE. A comparison: the efficacy of sevoflurane-nitrous oxide or propofol-nitrous oxide for the induction and maintenance of general anesthesia. J Clin Anesth 1996; 8: 639-43
[6] Schmidt J, Fechner J, Fritsch B, et al. [Propofol-remifentanil versus sevoflurane-remifentanil for anesthesia for pediatric procedures in infants, children and adolescents]. Der Anaesthesist 2001; 50: 757-66
, 百拇医药
[7] Hcker J, Tonner PH, Bllert P, Paris A, Scholz J, Meier-Paika C, Bein B. Propofol/remifentanil vs sevoflurane/remifentanil for long lasting surgical procedures: a randomised controlled trial. Anaesthesia. 2006，61(8):752-7
[8] Galinkin JL，Fazi LM，Cuy RM，et al. Use of intranasal fentanyl in chilˉdren undergoing myringotomy and tube placement during halothane and sevoflurane anaesthesia.Anesthesiology，2000，93:1378-1383
[9] Hofer CK, Zollinger A. Buchi S,et al. Patient well – being after general anaesthesia: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia. Br J Anaesth,2003,91:631-637
, http://www.100md.com
[10] Yang H, Choi PT, McChesney J, Buckley N. Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery. Can J Anaesth. 2004,51(7):660-7
[11] Sneyd JR, Andrews CJ, Tsubokawa T. Comparison of propofol/remifentanil and sevoflurane/remifentanil for maintenance of anaesthesia for elective intracranial surgery. Br J Anaesth. 2005，94(6):778-83
, http://www.100md.com(王 策)
瑞芬太尼复合异丙酚麻醉与瑞芬太尼复合七氟醚麻醉在诱导、维持、苏醒恢复以及PONV的发生上均无统计学上的差异。[10]瑞芬太尼分别与以上两种药物的联合应用可以达到一种接近理想的效果，我们可认为两种麻醉方法均可安全、确实有效地用于高龄危重患者。
参考文献
, 百拇医药
[1]余淑珍.刘保江.瑞芬太尼的药理学、临床研究和应用进展[J].国外医学：麻醉学与复苏分册,2004,25(6):356-357
[2] 宁捷,冯燕春,何艺. 瑞芬太尼复合异丙酚静脉全麻在老年病人上腹部手术中的应用[J].右江民族医学院学报，2006，28(3):410-411
[3] Fanelli G, Berti M, Cadsiti A. Fast-track anaesthesia for laparoscopic cholecystectomy: a prospective, randomized, multicentre, blind comparison of desflurane-remifentanil or sevoflurane-remifentanil. Eur J Anaesthesiol, 2006,23: 861-867
[4] Ku AS, Hu Y, Irwin MG, et al. Effect of sevoflurane/nitrous oxide versus propofol anaesthesia on somatosensory evoked potential monitoring of the spinal cord during surgery to correct scoliosis.Br J Anaesth 2002; 88: 5027
, 百拇医药
[5] Lien CA, Hemmings HC, Belmont MR, Abalos A, Hollmann C, Kelly RE. A comparison: the efficacy of sevoflurane-nitrous oxide or propofol-nitrous oxide for the induction and maintenance of general anesthesia. J Clin Anesth 1996; 8: 639-43
[6] Schmidt J, Fechner J, Fritsch B, et al. [Propofol-remifentanil versus sevoflurane-remifentanil for anesthesia for pediatric procedures in infants, children and adolescents]. Der Anaesthesist 2001; 50: 757-66
, 百拇医药
[7] Hcker J, Tonner PH, Bllert P, Paris A, Scholz J, Meier-Paika C, Bein B. Propofol/remifentanil vs sevoflurane/remifentanil for long lasting surgical procedures: a randomised controlled trial. Anaesthesia. 2006，61(8):752-7
[8] Galinkin JL，Fazi LM，Cuy RM，et al. Use of intranasal fentanyl in chilˉdren undergoing myringotomy and tube placement during halothane and sevoflurane anaesthesia.Anesthesiology，2000，93:1378-1383
[9] Hofer CK, Zollinger A. Buchi S,et al. Patient well – being after general anaesthesia: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia. Br J Anaesth,2003,91:631-637
, http://www.100md.com
[10] Yang H, Choi PT, McChesney J, Buckley N. Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery. Can J Anaesth. 2004,51(7):660-7
[11] Sneyd JR, Andrews CJ, Tsubokawa T. Comparison of propofol/remifentanil and sevoflurane/remifentanil for maintenance of anaesthesia for elective intracranial surgery. Br J Anaesth. 2005，94(6):778-83
, http://www.100md.com(王 策)