全麻拔管期瑞芬太尼对气道反应和吞咽功能恢复的影响

目的：观察瑞芬太尼-地氟醚复合全麻苏醒期持续泵注小剂量瑞芬太尼对气管拔管时气道反应，心血管反应以及吞咽功能恢复的影响。方法：40例ASAⅠ～Ⅱ级，年龄18-60岁，择期行耳鼻手术的全麻患者，随机分为瑞芬太尼组(R组)和对照组(C组)，每组20例。两组术中均为瑞芬太尼-地氟醚复合全麻维持至术毕。术毕R组继续泵注0.05μg?kg-1?min-1瑞芬太尼至拔管，C组泵注等量生理盐水至拔管，拔管后2min嘱患者吞咽10ml生理盐水。分别记录两组患者意识恢复的时间，气道反应，血流动力学变化，吞咽能力恢复以及其他的不良反应发生情况。结果：C组患者拔管即刻、拔管后3min、5min MBP、HR、RPP值均明显高于基础值(P < 0.05或P < 0.01), R组患者仅HR和RPP值在拔管即刻较基础值略升高（P < 0.05），余时间点MBP、HR与基础水平无统计学差异。R组呛咳发生率较C组明显下降(30% vs 65%,P < 0.05)。两组拔管后2min成功吞咽10ml生理盐水的例数无统计学差异(P>0.05)。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：术毕泵注0.05μg?kg-1?min-1瑞芬太尼可抑制拔管期心血管反应，减少呛咳发生，但不影响意识和吞咽功能的恢复时间

Effects of remifentanil on airway response and the recovery of swallowing function in general aneathesta decannulation period

Objective To study the influences of low dose remifentanil on airway reflexes,cardiovascular response and the restore of swallowing ability during emergence from remifentanil/desflurane-based general anesthesia and tracheal extubation.Methods Forty ASAⅠtoⅡ patients aged 18 to 60 years who scheduled for epigastric operations,were divided into two groups（n=20）：group C（remifentanil infusion was stopped at the end of the operations）,group R（remifentanil was continuously infusion at rate of 0.05 μg·kg-1·min-1 after the completion of the operations till extubation）.Anesthetic induction and maintenance were the same in the two groups.All patients were assigned to swallow 10 ml normal saline at 2 min after extubation.Time of awareness recovery,haemodynamics response,airway response,the restore of swallowing ability and other adverse side effects were assessed during emergence from general aneathesia and tracheal extubation.Results In group C,MBP,HR and RPP at the time of extubation,3min and 5min after extubation were all significantly higher than baseline level（P0.01 or P0.05）.In group R,except for a slight increase in HR and RPP at the time of extubation（P0.05）,MBP,HR and RPP had no significant difference at other time points when comparing to baseline.The cough rate in group R was lower than that in group C（30% vs 65%,P0.05）.The number of patients who can successfully swallow 10ml normal saline 2min after extubation were comparable between the two groups.There were no significant differences in times of opening eyes when called,extubation and OAAS scored 5 between the two groups.Conclusion The awareness recovery and the restore of swallowing ability were very fast after remifentanil/desflurane-combined general anesthesia.Remifentanil infusion at rate of 0.05 μg·kg-1·min-1 during the emergence from general anesthesia could reduce cardiovascular response to tracheal extubation and cough,without delay the time of awareness recovery and the recovery of swallowing ability.