瑞芬太尼的药理及临床应用.pptVIP

临床应用-清醒插管 L组：负荷量0.75 ?g/kg,持续输注0.075 ?g/kg/min H组:负荷量1. 5 ?g/kg,持续输注0.15 ?g/kg/min 临床应用-全麻的诱导和维持 优点: 有效地抑制插管反应 减少全麻药的用量,减轻对心血管的影响 苏醒、恢复快 有利于早期估价认知功能 缺点： 有时影响血流动力学 高剂量不能保证自主呼吸 价格 其他阿片类药的缺点 临床应用-剂量 临床应用-气管插管 I组是瑞芬太尼组，II组是芬太尼组 临床应用-日间手术麻醉 临床应用-日间手术麻醉 临床应用-神经外科手术 优点： 有利于术后及时评估神经功能 有利于控制血流动力学 可和吸入麻醉药合用行控制性降压 有利于术中唤醒 不增加ICP 临床应用-神经外科手术 临床应用-眼科手术 降低眼内压，降低司可林、气管插管引起的眼内压升高 不影响房水循环 可用于青光眼等手术 剂量同其它手术 临床应用-CABG 有效控制血流动力学 大剂量使用没有累积，有利于早期拔管，适合快通道麻醉 不影响心肌收缩力 降低氧耗 临床应用-CABG 临床应用-CABG Table 2. Response to Surgical Stimulus and Cumulative Doses Remifentanil Fentanyl Response to induction Count (%) Count (%) No. of subjects with one or more responses 62 (41%) 50 (32%) Nature of response ? ? Hypotension 54 (36%) 47 (31%) Bradycardia 16 (11%)* 7 (5%)* Response to intubation ? ? No. of subjects with one or more responses 39 (26%) 43 (28%) Nature of response ? ? Hypertension 38 (25%) 43 (28%) Tachycardia 3 (2%) 1 (1%) Cumulative propofol induction dose (mg/kg) 0.74 ± 0.30 0.71 ± 0.26 Cumulative study drug bolus dose (μg/kg) at intubation 0.05 ± 0.25 10 ± 1.37 Response to skin incision ? ? No. of subjects with one or more responses 48 (32%)* 109 (71%)* Nature of response ? ? Hypertension 45 (30%) 109 (71%) Tachycardia 3 (2%) 2 (1%) Isoflurane ET concentration at skin incision 0.4 ± 0.2 0.4 ± 0.2 Cumulative study drug bolus dose (μg/kg) at skin incision 0.8 ± 1.2 12.4 ± 3.6 Response to maximum sternal spread ? ? No. of subjects with one or more response 26 (17%)* 67 (44%)* Nature of response ? ? Hypertension 25 (17%)* 65 (42%)* Tachycardia 1 (1%) 6 (4%) Isoflurane ET concentration at maximum sternal spread 0.4 ± 0.2 0.6 ± 0.2 Cumulative study opioid bolus dose (μg/kg) at sternal spread 1.7 ± 1.6 16.9 ± 3.9 Response to aortic cannulation ? ? No. of subjects with one or more responses 8 (5%) 12 (8%) Nature of response ? ? Hypertension 5 (3%) 11 (7%) Tachycardia 1 (1%) 3 (2%) Isoflurane ET conce