Burmeister M A, Brauer P, Wintruff M, Graefen M, Blanc I, Standl T G
Department of Anaesthesia and Department of Urology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Anaesthesia. 2002 Sep;57(9):877-81. doi: 10.1046/j.1365-2044.2002.02820.x.
This study examined the intra-operative and postoperative characteristics of a remifentanil infusion alone, or intermittent fentanyl bolus admistration combined with a propofol infusion, for the anaesthetic management of patients undergoing shock wave lithotripsy. One of the key parameters investigated was the time to discharge. Fifty patients scheduled for extracorporeal shock wavelithotripsy (ESWL) were randomly allocated to receive either a continuous infusion of 0.2-0.4 micro g.kg-1.min-1 of remifentanil (Group 1) or a bolus of 3 micro g.kg-1 fentanyl followed by a continuous infusion of propofol at a rate of 2 mg.kg-1.h-1 with additional boluses of 0.05 mg fentanyl administered as required (Group 2). Both anaesthetic techniques were found to provide satisfactory analgesia and intra-operative conditions for ESWL. However, patients in the remifentanil Group 1 showed a higher incidence of nausea (52% vs. 0%, p < 0.01) and retching (36% vs. 0%, p < 0.01) 120 min following ESWL compared to Group 2. This resulted in prolonged discharge times (p < 0.01) in this group. We found that remifentanil used as the sole agent failed to demonstrate any advantage over the combination of fentanyl/propofol with regard to rapid recovery and discharge following anaesthesia for extracorporal shock wave lithotripsy.
本研究探讨了单独输注瑞芬太尼，或间断推注芬太尼联合输注丙泊酚用于冲击波碎石术患者麻醉管理的术中和术后特征。研究的关键参数之一是出院时间。50例计划行体外冲击波碎石术（ESWL）的患者被随机分为两组，分别接受持续输注0.2 - 0.4μg·kg⁻¹·min⁻¹的瑞芬太尼（第1组），或先推注3μg·kg⁻¹芬太尼，随后以2mg·kg⁻¹·h⁻¹的速率持续输注丙泊酚，并根据需要额外推注0.05mg芬太尼（第2组）。结果发现，两种麻醉技术均能为ESWL提供满意的镇痛效果和术中条件。然而，与第2组相比，第1组（瑞芬太尼组）患者在ESWL后120分钟时恶心发生率更高（52% vs. 0%，p < 0.01）、干呕发生率更高（36% vs. 0%，p < 0.01）。这导致该组患者出院时间延长（p < 0.01）。我们发现，在体外冲击波碎石术麻醉后的快速恢复和出院方面，单独使用瑞芬太尼相较于芬太尼/丙泊酚联合应用并无优势。
