小剂量瑞芬太尼对全麻拔管期心血管反应的影响

摘要：目的探讨小剂量瑞芬太尼在预防拔管期心血管反应的有效性及安全性。方法将164例择期行上腹部手术的患者随机分
为A组（41例）、B组（43例）、C组（40例）和D 组（40例），A、B、C组分别于手术结束时给予0.05、0.10、0.20 μg·kg-1·min-1泵注瑞芬
太尼直至拔管，D组拔管前不给任何药物。观察患者麻醉前(T1)，拔管时(T2)和拔管后1 (T3)、3 (T4)、5 min(T5)时的血流动力学
变化，苏醒时间及拔管后不良反应。结果各组在T2、T3时段的SBP、DBP及HR显著高于T1时段(P<0.05)，A、B、C 3组显著低
于D组，且B组和C组显著低于A组(P<0.05)。各组患者的自主呼吸恢复时间、清醒时间比较，差异无统计学意义（P>0.05）。A
组和B组恶心呕吐、呛咳不良反应发生率均显著低于C组，差异有统计学意义（P<0.05），而A组和B组之间差异无统计学意义
（P>0.05）。结论0.10 μg·kg-1·min-1瑞芬太尼应用于预防拔管期心血管反应的效果最佳，且不延长苏醒时间，不良反应少。

Effect of small-dose remifentanil on cardiovasclular response to tracheal extubation after general anesthesia

Objective To explore the efficacy and safety of small-dose remifentanil for attenuating cardiovascular response to tracheal extubation after surgery with general anesthesia.Methods A total of 164 patients scheduled for upper abdominal operation were randomized into groups A(n=41),B(n=43),C(n=40) and D(n=40).In groups A,B,and C,the patients received continuous infusion of remifentanil at the doses of 0.05,0.10 and 0.20 μg·kg-1·min-1,respectively,while those in group D were not given any drug before tracheal extubation.The change of systolic blood pressure(SBP),diastolic blood pressure(DBP) and heart rate(HR) were recorded before induction of anesthesia(T1),at the time of extubation(T2),and at 1 min(T3),3 min(T4),and 5 min(T5) after extubation.The recovery time and adverse effect of extubation were recorded.Results In each group,SBP,DBP and HR at T2 and T3 were significantly higher than those at T1(P<0.05).SBP,DBP and HR were significantly higher in groups A,B and C than in group D(P<0.05),and significantly higher in groups A and B than in group C.The time of spontaneous breath recovery and awaking showed no significant difference in the 4 groups(P>0.05).The rates of adverse effect(nausea and vomiting) in groups A and B were significantly lower than that in group C(P<0.05),but comparable between groups A and B(P>0.05).Conclusions Remifentanil at the optimal dose of 0.10 μg·kg-1·min-1 can effectively prevent cardiovasclular response to tracheal extubation and reduce the adverse effect associated with anesthesia without prolonging the recovery time.