持续输注瑞芬太尼和右美托咪定对神经外科术后拔管期的影响研究  

Effects of remifentanil and dexmedetomidine on tracheal extubation in patients undergoing neurosurgery

作　　者：王海丽[1] 郝睿 潘华[1] 屈海波[1] WANG Haili;HAO Rui;PAN Hua;QU Haibo(Department of Anesthesia,Sanmenxia Central Hospital,Henan 472000,China)

机构地区：[1]河南省三门峡市中心医院麻醉科

出　　处：《现代医药卫生》2019年第20期3096-3099,3103,共5页Journal of Modern Medicine & Health

基　　金：河南省三门峡市科技局科研项目（2016030312）

摘　　要：目的比较瑞芬太尼与右美托咪定持续输注对神经外科手术患者苏醒质量的影响。方法将80例择期行幕上开颅肿瘤切除术男性患者随机分为瑞芬太尼组(38例)和右美托咪定组(42例)。麻醉诱导包括异丙酚2mg/kg,瑞芬太尼效应室靶控浓度2ng/mL输注,静脉注射罗库溴铵0.6mg/kg,肌松起效后经口插入加强钢丝气管导管,连接麻醉机控制呼吸。麻醉维持包括瑞芬太尼效应室靶控浓度2ng/mL输注、异丙酚效应室靶控浓度3μg/mL输注、吸入七氟醚。硬脑膜缝合结束时,瑞芬太尼组持续使用瑞芬太尼,右美托咪定组更换为右美托咪定。瑞芬太尼组以效应室靶控浓度2ng/mL输注,右美托咪定组先以1μg/kg负荷剂量静脉输注,10min输注完毕后继续静脉泵注0.2mg/kg/h。手术结束后停止异丙酚的泵入,瑞芬太尼或右美托咪定继续泵入,待患者复苏达拔管条件后予吸痰拔管。拔管后停用右美托咪定或瑞芬太尼。记录拔管时呛咳评分、拔管后5min警觉镇静(OAA/S)评分、自主呼吸恢复时间、拔管时间、出手术室时间、术后复苏监护病房(PACU)停留时间、拔管后5min外周血S100B蛋白及皮质醇浓度。记录拔管前5min、拔管即刻、拔管后1min、拔管后3min、拔管后5min呼吸频率、心率及平均动脉压(MAP)。记录苏醒期不良事件发生情况。结果右美托咪定组呛咳评分较高(P<0.05)。两组患者拔管后5minOAA/S评分比较差异无统计学意义(P>0.05),但右美托咪定组评分为3分的患者例数多于瑞芬太尼组,评分为4分的患者例数少于瑞芬太尼组(P<0.05)。瑞芬太尼组自主呼吸恢复时间及拔管时间明显延长(P<0.05),出手术室时间及PACU停留时间比较差异无统计学意义(P>0.05)。右美托咪定组拔管后S100B蛋白水平更低(P<0.05),皮质醇水平组间比较差异无统计学意义(P>0.05)。瑞芬太尼组拔管前5min及拔管即刻呼吸频率较慢(P<0.05)。拔管后3min、5min右美托�Objective To compare the effects of remifentanil and dexmedetomidine on the prevention of cough during emergence in patients undergoing neurosurgery. Methods Eighty male patients undergoing supratentorial craniotomy were randomly divided into remifentanil group(group R) and dexmedetomidine group( group D).Anesthesia was induced with propofol 2 mg/kg,target-controlled infusion(TCI) of remifentanil with effect-site concentration of 2 ng/mL and rocuronium 0.6 mg/kg.A strengthening steel tracheal catheter was intubated after muscular flaccidity and connected to the ventilator for respiratory control.Anesthesia was maintained with remifentanil(2 ng/mL),TCI of propofol(3 μg/mL)and sevoflurane inhalation.In group R,TCI of remifentanil with effective-site concentration of 2 ng/mL was maintained during emergence until extubation.In group D,remifentanil was discontinued after the dural was closed,dexmedetomidine was given with loading dose of 1 μg/kg in 10 min and maintained with 0.2 mg/(kg·h) until extubation.The cough grade,hemodynamic values,respiration rate,and other recovery profiles were evaluated during the periextubation period. Results Compared with group R,the cough score was higher and the concentration of S100B was lower in group D( P <0.05).The time of spontaneous breathing recovery and extubation was shorter in group D( P <0.05).There was no significant difference of the Observer′s Assessment of Alertness/Sedation Scale(OAA/S) score between the two groups ( P > 0.05). However,the incidence of 3 points in group D was higher,and the lower of that of 4 points( P <0.05).The respiratory rate was lower in group R at the time of extubation and 3 min after extubation than group D( P <0.05).The heart rate andmean artery pressure at 3 min and 5 min after extubation and the incidence of nausea and vomiting in group D was lower than those in group R( P <0.05). Conclusion Remifentanil could reduce emergence of cough after neurosurgery more effectively than dexmedetomidine.However,dexmedetomidine might have the effect

关 键 词：瑞芬太尼 右美托咪定 脑保护 呛咳反射 

分 类 号：R741[医药卫生—神经病学与精神病学] R614[医药卫生—临床医学]