目的 通過觀察瑞芬太尼對老年高血壓患者全身麻醉中血壓、心率(HR)、血細胞含氧量的影響,評價瑞芬太尼的有效性、安全性及可控性。方法 收集60例年齡65～84歲需行全身麻醉的老年高血壓患者,隨機分為對照組(30例)和觀察組(30例),對照組用異丙酚麻醉,觀察組用瑞芬太尼配合異丙酚麻醉。觀察老年高血壓患者全身麻醉中的血壓、HR的變化及血細胞含氧情況。結果 對照組和觀察組兩組患者術前、術畢、拔管及拔管后收縮壓(SBP)、舒張壓(DBP)、HR比較無顯著差異;對照組和觀察組呼吸恢復時間、睜眼時間、拔管時間比較,觀察組中各時間均早于對照組,差異有統(tǒng)計學意義(P<0.05);對照組和觀察組中手術前和手術后靜脈血氧飽和度(S_jvO₂)觀察比較,術前兩組無明顯差異,術后觀察組的SjvO₂高于對照組,差別有統(tǒng)計學意義(P<0.05)。結論 瑞芬太尼有助于老年患者麻醉過程中血壓和心率的穩(wěn)定,代謝時間較快,持續(xù)時間較短,對患者后期恢復較快,對S_jvO₂的穩(wěn)定和恢復有較好的作用,有著顯著的推廣價值。

Objective To observe the effect of remifentanil on blood pressure, heart rate, and oxygen content of blood cells in elderly hypertension after general anesthesia, in order to evaluate the effectiveness, safety, and controllabililty. Methods Patients (60 cases, 65—84 year old with hypertension after general anesthesia were selected and divided randomly into control group (30 cases) and observation group (30 cases). Anesthesia with propofol was given to the patients in control group, and the anesthesia with remifentanil was given to the patients in observation group. The observation indexes included the changes of blood pressure and heart rate, and the oxygen content of blood cells. Results The difference of SBP, DBP, and HR in pre-operation, post-operation, extubation, and post-extubation between two groups had no significance (P > 0.05). Breathing recovery time, eye opening time, and extubation time of control group were shorter than those in observation group, with statistical significances (P < 0.05). The difference of S_jvO₂ between two groups in pre-operation had no significance (P > 0.05), but S_jvO₂ in observation group was higher than that in control group in post-operation with statistical significance (P < 0.05). Conclusion It is helpful for using remifentanil to stabilize the blood pressure and heart rate for the patients during anesthesia. It has better metabolism time, shorter duration time, and faster late recovery, and was effective in stabilize and recovery S_jvO₂. Application of remifentanil has better effect, lower adverse reactions and complications and awaked easily and safety, which is worth of being generalized.