瑞芬太尼与右美托咪啶对口腔颌面外科全麻苏醒期的影响  

Effects of remifentanil and dexmedetomidine on recovery profiles after oral and maxillofacial surgery

作　　者：陈佳伟[1] 吕翔[1] 张凌[1] 陈志峰[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海200011

出　　处：《上海口腔医学》2016年第1期101-104,共4页Shanghai Journal of Stomatology

摘　　要：目的 ：观察瑞芬太尼与右美托咪啶对口腔颌面外科全麻苏醒期的影响。方法 ：口腔颌面外科全麻手术患者60例,性别不限,年龄18~65岁,随机分为3组：瑞芬太尼组（R组）、右美托咪定组（D组）和对照组（C组）。在手术结束10 min前,R组予以持续TCI输注瑞芬太尼,血浆浓度为1.5 ng/m L;D组给予右美托咪定0.5μg/kg;C组给予生理盐水。观察3组患者苏醒期间血流动力学变化、Ramsay镇静评分、呛咳人数、躁动人数、拔管时间和不良反应的发生率。使用SPSS 20.0软件包对数据进行统计学分析。结果：R组和D组心率、平均血压在拔管时显著低于C组（P〈0.05）;R组和D组Ramsay评分在拔管后5、10min显著高于C组,且D组显著高于R组（P〈0.05）;R组和D组发生呛咳和躁动的人数均显著低于C组（P〈0.05）,3组患者拔管时间无显著差异。结论：瑞芬太尼和右美托咪定均可明显减轻口腔颌面外科全麻患者苏醒期血流动力学变化,减少呛咳和躁动,不延长拔管时间。右美托咪定较瑞芬太尼在苏醒期间能提供更长时间的镇静作用。PURPOSE： To investigate the effects of remifentanil and dexmedetomidine on recovery period after oral and maxillofacial surgery. METHODS： Sixty cases undergoing oral and maxillofacial surgery were randomly divided into 3 groups, including remifentanil group （group R）, dexmedetomidine group （group D） and normal saline group （group C）. Ten minutes before the end of surgery, the patients were given target control infusion of remifentanil at effect-site concentration of 1.5 ng/mL in group R or dexmedetomidine 0.5 Ixg/kg in group D or normal saline in group C, respectively. The haemodynamic parameters, Ramsay scales, coughing, agitation were recorded. Extubation time and incidence of adverse events were observed as well. Statistical analysis was performed using SPSS20.0 software package. RESULTS： The mean arterial pressure and heart rate at the time of extubation were significantly lower in group D and group R than those in group C （P〈0.05）. The Ramsay scores were significantly better in group D and group R than in group C at the time point of 5 minutes and 10 minutes after extubation, and the score in group D was better than in group R at the same time （P〈 0.05）. The incidences of coughing and agitation were significantly lower in group D and group R than in group C （P〈0.05）. There was no significant difference in extubation time. CONCLUSIONS： Dexmedetomidine and remifentanil can reduce the haemodynamic responsiveness, coughing and agitation during the recovery period of oral and maxillofacial surgery without extending the extubation time. Dexmedetomidine can provide longer sedation time than TCI of remifentanil.

关 键 词：瑞芬太尼 右美托咪定 全麻苏醒期 口腔颌面手术 

分 类 号：R782.054[医药卫生—口腔医学]