麻醉药物选择对鼻、咽腔手术患者苏醒期躁动的影响

目的:探讨不同麻醉用药方案对全麻下行鼻、咽腔手术患者苏醒期躁动情况的影响。方法:将106例拟于全身麻醉下行鼻、咽腔手术的患者随机分为A组和B组。麻醉诱导:A组患者静脉注射瑞芬太尼0.8μg/kg,丙泊酚2 mg/kg和罗库溴铵0.6 mg/kg;B组静脉注射芬太尼2μg/kg,丙泊酚2 mg/kg和维库溴铵0.1 mg/kg。麻醉维持:A组患者吸入七氟醚1~1.5MAC、持续静脉泵注瑞芬太尼0.08~0.15μg/(kg.min)和根据需要分次静脉注射罗库溴铵0.3 mg/kg;B组患者吸入异氟醚1~2 MAC、静脉注射芬太尼1μg/kg和根据需要分次静脉注射维库溴铵0.04 mg/kg。观察并记录患者从停止吸入麻醉药到自主呼吸恢复、拔除气管导管以及认知功能恢复的时间;观察并记录患者麻醉恢复期躁动的情况及发生率。结果:A组患者躁动发生率明显低于B组(P0.001);A组患者自主呼吸恢复时间、气管导管拔管时间以及认知功能恢复时间均明显短于B组(P0.01)。结论:采用七氟醚、瑞芬太尼和罗库溴胺的麻醉方法能够减少全麻患者苏醒期躁动的发生率并缩短麻醉苏醒时间。

Effect of Anesthetics on Emergence Agitation in Patients Undergoing Intranasal and Pharyngeal Surgery

Objective：To investigate the effect of anesthetics on the emergence agitation of patients undergoing intranasal and pharyngeal surgery. Methods： 106 patients scheduled to undergo selected intranasal and pharyngeal surgery under general anesthesia were recruited. All patients were allocated randomly either to group A and B. Anesthesia was induced by administering（iv） remifentanil 0. 8 μg/kg, propofol 2 mg/kg, rocuronium 0. 6 mg/kg in group A and fentanyl （2 μg/kg） ,propofol （2 mg/kg） ,vecuronium （0.1 mg/kg） in group B. Anesthesia was maintained with inhaled sevoflurane（1-1. 5 MAC）, remifentanil infused intravenously 0. 08-0. 15μg/（ kg · min） ] and rocuronium （0.3 mg / kg iv,as required） in group A and inhaled isoflurane （142 MAC） , fentanyl （1 μg/kg iv, as required）, vecuronium （0.04 mg/kg iv,as required） in group B during the procedure. The times of spontaneous respiration recovery, extubation and cognitive function recovery were recorded after the anesthetics administration was stopped. The severity and occurrence of emergence agitation were also oberserved and recorded. Results：There was no significant difference in age, sex and weight between two groups（P 〉0.05）. Compared with group B, the incidence of agitation was significantly higher in group A during awaking stage of anaesthesia （P 〈0. 001 ）. The times of spontaneous respiration recovery,extubation and cognitive function recovery were significantly smaller in A group than in B group（P〈0.01）. Conclusion：The incidence of agitation and time of recovery from anesthesia is significantly reduced in patients by administration of remifentanil, propofol and rocuronium.