瑞芬太尼在全麻拔管期的观察及护理

目的探讨全麻苏醒期持续泵注小剂量瑞芬太尼对患者拔管期的影响及护理。方法选择60例ASAⅠ～Ⅱ级,年龄31～58岁,择期行肝胆手术的全麻患者,随机分为瑞芬太尼组（A组）和对照组（B组）,每组30例。A组术毕继续泵注0.05μg·kg-1·min-1瑞芬太尼至拔管,B组泵注等量生理盐水至拔管。观察两组患者意识恢复的时间、气道反应、血流动力学变化、吞咽能力恢复以及不良反应发生情况。结果 A组患者拔管时、拔管后3min、5min心率、血压值均明显高于基础值（P〈0.05）,呛咳率明显低于B组;两组患者术毕至呼唤睁眼时间、拔管的时间及OAAS评分达5分的时间差异均无统计学意义。结论全麻苏醒期泵注瑞芬太尼可抑制拔管期心血管反应,减少呛咳发生,提高患者的舒适度,为优质护理服务提供保障。

Observation and Nursing of Remifentanil at Period of Anesthesia Extubation

Objective To explore the impact and nursing of continuous infusion of small doses of remifentanil in patients at the period of general anesthesia extubation. Methods 60 patients, ASA Ⅰ to Ⅱ, aged 31 to 58 years, undergoing elective gallbladder surgery general anesthesia, were randomly divided into remifentanil group A and control group B, with 30 cases in each group. Group A continued to be infused with 0.05·kg-1·min-1 remifentanil to extubation, group B received normal saline infusion to extubation, to observe the patients＇ recovery time of consciousness, airway response, hemodynamic changes, ability to restore swallowing and adverse events. Results Heart rate, blood pressure values in group A of patients at extubation, after extubation 3 min, 5 min were significantly higher than the base value （P 0.05）, cough was significantly lower than that in group B; two groups of patients had no statistically significant difference in time of surgery to calling for opening eyes, extubation time and OAAS score of 5 points. Conclusion General anesthesia infusion of remifentanil at recovery period can inhibit the cardiovascular responses at extubation, reduce the occurrence of cough, increase the patients＇ comfort, to provide guarantee for high-quality nursing.