不同输注剂量瑞芬太尼对神经外科苏醒拔管时心血管反应的影响

目的观察三种输注剂量瑞芬太尼对神经外科术毕苏醒和拔管时心血管反应的影响。方法 45例择期行神经外科手术患者,ASAⅠ~Ⅱ,随机分为3组:R1组15例,输注剂量为0.08μg/(kg.min);R2组15例,输注剂量为0.04μg/(kg.min);R3组15例,输注剂量为0.02μg/(kg.min)。全部患者用异丙酚、瑞芬太尼持续泵注和维库溴铵间断注射维持全麻,术毕各组持续输注不同剂量瑞芬太尼,观测术前、苏醒时、拔管时、拔管后2 min、拔管后5 min的动脉血压、心率、血氧饱和度。结果与基础值比较,R1组动脉血压、心率无显著变化(P>0.05),R2组和R3组动脉血压、心率在T3和T4时点增快(P<0.05);于T3和T4时点,R2和R3组动脉血压、心率均升高,与R1组比较有显著性差异。结论持续输注剂量0.08μg/(kg.min)瑞芬太尼可显著抑制神经外科术毕苏醒和拔管时呛咳引起的血压增高、心率增快等心血管反应。

The Effect of Different Infusion Doses of Remifentanil on the Cardiovasclular Response upon Regaining Consciousness and Tracheal Extubation from Neurosurgery Anesthesia

Objective To observe the effect of different infusion doses of remifentanil on the hemodynamic response upon regaining consciousness and tracheal extubation from neurosurgery anesthesia.Methods 45 ASA ⅠorⅡpatients scheduled for neurosurgery under general anesthesia were randomly allocated to one of 3 groups（n=15 each）：group R1（infusion rate=0.08μg/（kg·min））;group R2（infusion rate=0.04μg/（kg·min））;group R3（infusion rate=0.02μg/（kg·min））.All patients were anesthetized with general anesthesia by continuous infusion of propofol,remifentanil and intermittent injection of vecuronium.After the operation was finished,remifentanil of different doses were continuously infused in different groups.Arterial blood pressure（ABP）,heart rate（HR） and SPO2 were recorded at the time point of before operation,regaining consciousness,extubating,2 min after extubation and 5 min after extubation.Results ABP and HR increased at the time of T3 and T4（P〈0.05）in R2 and R3 group as compared to the baseline values,but remained stable in R1 group（P〈0.05）;ABP and HR increased at the time of T3 and T4 in R2 and R3 group as compared to the R1（P〈0.05）.Conclusion The continuous infusion of 0.08μg/（kg·min） can significantly blunt the hemodynamic response to consciousness from neurosurgery anesthesia and tracheal extubation.