术后泵注瑞芬太尼对围拔管期的影响  

Effects of remifentanil on tracheal extubation in the patient undergoing superficial surgery

作　　者：徐磊[1] 朱中良[1] 鲍红光[1] 

机构地区：[1]南京医科大学附属南京第一医院麻醉科,210006

出　　处：《临床麻醉学杂志》2011年第12期1159-1161,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨术后泵注不同剂量瑞芬太尼对围拔管期患者心血管反应和麻醉恢复的影响。方法择期行乳腺腺瘤切除术或甲状腺腺瘤切除术患者80例,随机均分为四组,术毕分别将瑞芬太尼泵速减至0.01、0.03、0.05μg·kg-1·min-1(R1、R2、R3组),C组停止泵注瑞芬太尼。记录瑞芬太尼减量前(T1)、患者清醒吸痰时(T2)和拔管时(T3)的SBP、DBP、HR。观察患者对导管留置的耐受程度以及疼痛VAS评分。结果与T1时比较,T2、T3时四组患者SBP、DBP明显升高,HR显著增快(P<0.05)。T2、T3时R1、R2、R3组SBP、DBP明显低于C组,HR明显慢于C组(P<0.05)。自主呼吸恢复、睁眼和拔管时间R1、R2、R3组显著长于C组(P<0.05),R3组显著长于R1、R2组(P<0.05)。结论瑞芬太尼全凭静脉麻醉后以0.01～0.03μg·kg-1·min-1速率持续静脉输注可减轻患者围拔管期心血管反应,对呼吸抑制作用较弱。Objective To observe the efficacy of remifentanil on the hemodynamics and recovery during tracheal extubatioi2. Methods Eighty patients, ASA Ⅰ or Ⅱ, scheduled for breast or thyroid operation, were randomly divided into four groups. The infusion rates of remifentanil were reduced to 0 （group C）, 0.01 （ group R1 ）, 0.03 （ group R2 ）, and 0.05 （ group R3）μg·kg-1 ·min-1 respectively in the recovery period. Hemodynamics, trachea tube tolerance and VAS score were observed before the end of operation （T1）, during trachea suction （T2） and extubation （T3）. Results Compared with T1, SBP, DBP, and HR increased in all groups at T2 （P〈0. 05）. Compared with group C, SBP, DBP and HR decreased in groups R1, R2 and R3 at T2 and T3 （P〈0. 05）, and the recovery of respiratory, eyes opening and extubation time were all prolonged in groups R1, R2 and R3. Conclusion Continuous infusion of remifentanil at 0.01-0. 03μg.kg-1 .min-1 can effectively prevent hemodynamic reaction to extubation in patients undergoing TIVA anesthesia with a mild respiratory depression.

关 键 词：瑞芬太尼 围拔管期 心血管反应 

分 类 号：R614[医药卫生—麻醉学]