目的 通过观察瑞芬太尼对老年高血压患者全身麻醉中血压、心率(HR)、血细胞含氧量的影响,评价瑞芬太尼的有效性、安全性及可控性。方法 收集60例年龄65～84岁需行全身麻醉的老年高血压患者,随机分为对照组(30例)和观察组(30例),对照组用异丙酚麻醉,观察组用瑞芬太尼配合异丙酚麻醉。观察老年高血压患者全身麻醉中的血压、HR的变化及血细胞含氧情况。结果 对照组和观察组两组患者术前、术毕、拔管及拔管后收缩压(SBP)、舒张压(DBP)、HR比较无显著差异;对照组和观察组呼吸恢复时间、睁眼时间、拔管时间比较,观察组中各时间均早于对照组,差异有统计学意义(P<0.05);对照组和观察组中手术前和手术后静脉血氧饱和度(S_jvO₂)观察比较,术前两组无明显差异,术后观察组的SjvO₂高于对照组,差别有统计学意义(P<0.05)。结论 瑞芬太尼有助于老年患者麻醉过程中血压和心率的稳定,代谢时间较快,持续时间较短,对患者后期恢复较快,对S_jvO₂的稳定和恢复有较好的作用,有着显著的推广价值。

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.