雷米芬太尼靶控输注对气管插管全身麻醉患者拔管反应的影响  

Effect of target-controlled infusion of remifentanil on the responses to tracheal extubation in patients under general anaesthesia

作　　者：王林[1] 孙建宏[1] 沈通桃[1] 张荦[1] 

机构地区：[1]扬州大学第二临床医学院(扬州市第一人民医院)麻醉科,江苏省225000

出　　处：《江苏医药》2016年第9期1045-1048,共4页Jiangsu Medical Journal

摘　　要：目的探讨雷米芬太尼靶控输注(TCI)对全身麻醉患者气管拔管反应的影响。方法全凭静脉麻醉下行鼻内窥镜手术患者60例随机均分为四组,麻醉苏醒期雷米芬太尼靶浓度分别为0μg/L(C组)、1.4μg/L(R1组)、1.7μg/L(R2组)和2.0μg/L(R3组)。于入室后5min(T0)、鼻腔填塞结束(T1)、气管拔管时(T2)、拔管后1min(T3)、3min(T4)、5min(T5)、10min(T6)和30min(T7)记录MAP和HR,检测T0、T1、T5和T7时的血浆皮质醇(Cor)、血糖(BG)和乳酸(LA)浓度,观察拔管后不良反应。结果 T5、T7时,R2、R3组血浆Cor值低于T0时(P<0.05)。T3、T4时,R2、R3组的MAP和HR均低于C、R1组(P<0.05)。R3组呛咳和咽痛评分低于R1、C组(P<0.05)。R3组呼吸抑制发生率高于其他三组(P<0.05)。R3组发生恶心、呕吐1例。R2、R3组患者无拔管记忆病例。结论雷米芬太尼TCI能有效地减轻全身麻醉患者气管拔管反应,选择靶浓度1.7μg/L较为合适。Objective To explore the effect of target-controlled infusion（TCI）of remifentanil on the responses to tracheal extubation in the patients under general anaesthesia.Methods Sixty patients undergoing nasal endoscopic surgery under total intravenous anesthesia were equally randomized into four groups.During extubation period,the patients were given TCI of remifentanil 0μg/L（group C）,1.4μg/L（group R1）,1.7μg/L（group R2）and 2.0μg/L（group R3）,respectively.MAP and HR were recorded at 5minutes after entering operation room（T0）,nasal packing（T1）,at the times of extubation（T2）,1minute（T3）,3minutes（T4）,5minutes（T5）,10minutes（T6）and 30minutes（T7）after extubation.Plasma concentrations of cortisol（Cor）,blood glucose（BG）and lactic acid（LA）were detected at T0,T1,T5 and T7.The complications were observed.Results Plasma levels of Cor in groups of R2 and R3were lower at T5 and T7than those at T0（P〈0.05）.MAP and HR at T3 and T4were lower in groups of R2 and R3than those in groups of C and R1（P〈0.05）.The scores of choking cough and sore throat were lower in group R3 than those in groups of R1 and C（P〈0.05）.The incidence of respiratory depression was higher in group R3 than that in the other three groups（P〈0.05）.Nausea and vomiting occurred in one case of group R3.No case in groups of R2 and R3had the remember about extubation.Conclusion Remifentanil TCI in the patients during recovery from general anaesthesia can effectively reduce the responses to tracheal extubation,for which a target concentration of 1.7μg/L is an appropriate choice.

关 键 词：雷米芬太尼 靶控输注 全身麻醉 气管拔管 

分 类 号：R614[医药卫生—麻醉学]