舒芬太尼、曲马多对雷米芬太尼苏醒期躁动的预防效应  

Effect of sufentanil and tramadol on preventing the restlessness during emergence after remifentanil-based general anesthesia

作　　者：王春光[1] 瞿慧[1] 艾青[1] 张志捷[1] 段满林[1] 徐建国[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院麻醉科,210002

出　　处：《临床麻醉学杂志》2007年第11期897-900,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨雷米芬太尼麻醉后苏醒期躁动的预防方案。方法180例ASAⅠ或Ⅱ级的择期腹腔镜胆囊切除术患者，随机分为曲马多1、2、3mg／kg组（Q1、Q2、Q3组），舒芬太尼0．1、0．2、0，3／μg／kg组（S1、S2、S3组），每组30例。术毕前30min缓慢静脉输入。观察各组的HR、MAP、SpO2、PETCO2、躁动评分（RS）、Ramsay镇静评分（RSS）、意识状态评分（OAAS）。观察时点：术毕前30min给药时（T1）、给药后10min（T2）、20min（T3）、30min（术毕停药）（T4）、40min（T5）、拔管前（T6）、拔管时（T7）、拔管后10min（T8）、20min（T9）。以及T6、T7时血浆皮质醇、血糖，全麻后身体舒适度评分（BCS）、拔管时间（术毕到拔管）、病人静脉自控镇痛（PCIA）用量和副作用。结果RS：T4～T8时Q1、Q2组分值高于Q3组（P〈0.05），Q3组高于S1、S2、S3组（P〈0．05）；T9时Q1、Q2组分值高于Q3、S1、S2、S3组（P〈0．05）。RSS：Q3、S1、S2、S3组在T6～T8时分值高于Q1、Q2组（P〈0．05）。OAAS：T6～T9时舒芬太尼组高于曲马多组（P〈0．05），T6时S1、S2、S3组组间差异有统计学意义（P〈0.05）。BCS：Q1、Q2、Q3组分值低于S1、S2、S3组（P＜0．05）。与T6比较，Q1、Q2、Q3组T7时皮质醇和血糖的升高值高于S1、S2、S3组（P〈0．05），Q1、Q2、Q3组按剂量递减（P〈0．05）。Q3组的主要副作用为呕吐，S3组的主要副作用为呼吸循环抑制和尿潴留。结论0.2μg／kg舒芬太尼预防雷米芬太尼麻醉后苏醒期躁动最佳，苏醒质量高，副作用少，术后镇痛药的用量明显减少。Objective To investigate the proposal of preventing the restlessness during emergence after remifentanil-based general anesthesia. Methods One hundred and eighty ASA class Ⅰ or Ⅱ patients undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly assigned into 6 groups of Q1 , Q2, Q3 ,S1, S2, and S3 with 30 cases each. Thirty minutes before the end of surgery, tramadol 1, 2, 3 mg/kg and sufentanil 0.1, 0.2, 0.3 μg/kg were administered in groups Q1 , Q2 , Q3 and groups S1 , S2 ,S3 respectively. HR, MAP, SpO2 , PETCO2 , Restlessness Score （RS）, Ramsay Sedative Score （RSS）, Observer/s Assessment of Alertness/ Sedation Score （OAAS） were recorded at 30 rain before drug administration（T1 ）, 10 min（T2 ）, 20 rain （T3） ,30 rain（T4 ） ,40 min（T5 ） after that, before extubation（T6 ）, during extubation（T7 ）, and 10 rain （T8） ,20 rain（T9 ） after extubation. In addition, cortisol and glucose in plasma at T6 and TT, Body Comfort Score （BCS）, extubation time, patient-controlled intravenous analgesia（PCIA） dosage and side reactions were observed. Results The RS of group Q1 and Q2 were apparently higher than group O3 at T6-T8 （P〈0.05）. The RS of group Q3were higher than group S1 , S2 and S3 （P〈0.05）. There were statistically significant differences of the RS at T9 （Q1, Q2 vs. Q3. S1 , S2 and S3, P〈0.05）. The RSS of groups Q3, S1, S2 and S3 were around 2 at T6-T9. The RSS of group Q1 and Q2 were about 1 at T6-T8. There were remarkable differences in OAAS at T6-T9 （Q1 , Q2 , O3 vs. S1, S2 , S3, P〈0. 05）. There were also significant differences in the values of OAAS in groups Q1 , Q2 and Q3 at T6. The BCS of sufentanil was obviously higher that of than tramadol （P〈0.05）. There were great differences in the increase a values of cortisol and glucose from T6 to T7 （Q1 , Q2, O3 vs. S1 , S2, S3 , P〈0. 05）. The values in them in group Q1 , Q2, O3 declined in an order of the dosages （P〈0. 05）. The major complica

关 键 词：雷米芬太尼 舒芬太尼 曲马多 苏醒期躁动 预防 

分 类 号：R614[医药卫生—麻醉学]