清醒血药浓度的丙泊酚联合氯诺昔康对全麻苏醒期间不良反应的影响

【目的】观察清醒血药浓度的丙泊酚（〈1．5μg／mL）联合氯诺昔康对全麻拔管期间不良反应的影响。【方法】将择期腹部手术40例随机分为Ⅰ、Ⅱ组，每组20例，两组患者均用咪唑安定＋芬太尼＋阿曲库胺＋丙泊酚静脉诱导后气管插管，术中以吸入异氟烷、靶控输注丙泊酚、间断追加阿曲库胺和芬太尼维持。Ⅰ组患者于手术前及术毕前30min分别静注氯诺昔康8mg，并于手术结束前15min将丙泊酚的血浆靶浓度调至1．2μg／mL直至拔管后5min；Ⅱ组给予等量生理盐水，并于手术结束前15min停用丙泊酚。观察记录术毕前30min时（T0）、缝皮时（T1）、手术结束时（T2）、拔管时（T3）、拔管后10min（T4）等时点的平均动脉压（MAP）和心率（HR）的变化，以及苏醒期的躁动评分、拔管时间、苏醒时间、主诉疼痛时间。【结果】与T0比较，Ⅰ组在T3时MAP有升高（P〈0．05）外，其余各时点MAP、HR均变化不大（P〉0．05）；Ⅱ组则在T1、T3、T4时，MAP和HR均有差异（P〈0．05）。Ⅰ组在T1、T3、T4时与Ⅱ组比较，MAP和HR差异均有显著性（P〈0．05）。Ⅰ组在苏醒期的躁动评分明显低于Ⅱ组（P〈0．01），拔管时间、苏醒时间比较差异无显著性，术后主诉疼痛时间Ⅰ组明显比Ⅱ组延长（P〈0．01）。【结论】清醒血药浓度联合氯诺昔康在全麻患者苏醒期镇痛效果好，不延长苏醒时间，能减少不良反应，维持较平稳的血液循环。

Effect of Propofol with Conscious Plasma Concentration Combined with Lornoxicam on Adverse Reaction After General Anesthesia

Objective]To investigate the effect of propofol with conscious plasma concentration combined with lornoxicam on adverse reaction during extubation after general anesthesia. Methods] Forty patients undergoing abdominal surgery were assigned randomly into two groups with 20 cases for each. All patients were induced with propofol combined with midazolam, fentanyl and atracurium, then maintained with isoflurane, propofol, atracurium and fentanyl. Patients in groupⅠreceived lornoxicam 8mg intravenously for 30min before surgery and the end of surgery separately. Before the end of surgery, plasma concentration of propofol infused by TCI was set to 1.2μg/mL until 5min after extubation. Those in group Ⅱ were given saline and propofol was stopped 15min before the end of surgery. All the data including MAP, HR at 30min before the end of operation(T0), suturation(T1), the end of operation(T2), extubation(T3), 10min after extubation(T4), emergence agitation scores, time to extubation, time to wake-up and complaining of pain were assessed. Results] MAP increased at T3(P<0.05) in groupⅠ. In group Ⅱ, both MAP and HR increased at T1, T3 and T4 (P<0.05). There were significant differences at T1, T3, T4 between two groups (P<0.05). Emergence agitation scores in group Ⅰwere significantly lower than those in groupⅡ(P<0.01). Time to complaining of pain in groupⅠwas significantly longer than that in groupⅡ(P<0.01). No statistical difference was found in time to extubation and wake-up. Conclusion] Propofol with conscious plasma concentration combined with lornoxicam can provide efficient pain relief during emergence after general anesthesia, which can produce hemodynamic stability, few adverse reactions and no influence on wake-up time.