小剂量瑞芬太尼预防全麻气管拔管时的心血管反应

目的:观察拔管前小剂量瑞芬太尼对预防全麻气管拔管反应的临床效果。方法:选择40例ASA分级Ⅰ、Ⅱ级的择期非心脏手术的全麻患者,随机分为对照组(C组)和瑞芬太尼组(R组),每组20例。二组患者麻醉的诱导和维持方式相同。麻醉维持采用吸入异氟醚,静脉微量泵持续泵注瑞芬太尼0.1~0.4μg.kg-1.m in-1,术毕C组停用瑞芬太尼,R组持续泵注0.1μg.kg-1.m in-1瑞芬太尼。分别记录三组患者拔管前、拔管时、拔管后1 m in、3 m in、5 m in等各时段的收缩压、舒张压、心率和拔管后1 m in,3 m in,5 m in潮气量、呼吸频率、血氧饱和度的变化。结果:C组拔管前后血压和心率相比差异有显著性(P<0.05),R组拔管前后血压和心率无显著性差异(P>0.05)。在拔管时及拔管后1 m in、3 m in、5 m in等时段R组SBP、DBP、HR变化与C组比较下降明显,差异有显著性(P<0.05或P<0.01)。拔管后两组患者VT、RR、Sp02均无显著性差异(P>0.05)。结论:拔管前小剂量静脉泵入瑞芬太尼能有效减轻拔管时的反应。

The Application of Low Dose Remifentanil to Prevent Cardiovascular Response in Tracheal Extubation

Objective To observe the effect of low dose remifentanil on cardiovascular response to tracheal extubation of patients.Methods Forty ASA Ⅰ-Ⅱpatients scheduled for un-cardiosurgery under general anesthesia were randomly divided into two groups:control group and remifentanil group.Anesthesia was induced with same method,maintained with inhalation of isoflurane and a continuous infusion of remifentanil(0.1~0.4 μg·kg~(-1)·min~(-1)).Continuous infusion of remifentanil(0.1 μg·kg~(-1) ·min~(-1)) was only in remifentanil group until extubation.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR) were recorded before extubation,at extubation,1 min,3 min and 5 min after extubation.Tidal volume(VT),respiratory rate(RR),pulse oxygen saturation(SpO_2) were also observed at 1 min,3min and 5 min after extubation.Results HR,SBP and DBP in control group were much higher than the basic value(P<0.05).There were significant difference between control group and remifentanil group(P<0.05,P<0.01) at extubation,1 min,3 min after extubation.But VT,PR,SpO_2 in two groups have no significant difference after extubation(P>0.05).Conclusion Continuous infusion of remifentanil may offer superior hemodynamic stability to extubation without compromising recovery from anesthesia.