小剂量瑞芬太尼恒速输注预防硬膜外阻滞麻醉结肠手术牵拉反应

目的观察小剂量瑞芬太尼持续输注辅助硬膜外阻滞麻醉下结肠手术中牵拉反应的防治效果。方法 60例择期结肠手术患者随机分为观察组和对照组各30例。均选择T11～12间隙硬膜外隙穿刺向头端置管3.5 cm,确认硬膜外导管在硬膜外腔后注入0.5%国产甲磺酸罗哌卡因6～15 mL。观察组在手术开始切皮前用微泵持续输注瑞芬太尼(0.05～0.1)μg/(kg.min)至关腹,对照组未用任何辅助药物。监测并记录麻醉前(T1)、切开腹膜前(T2)、手术牵拉结肠时(T3)、手术结束时(T4)患者的SBP、DBP、HR、SpO2变化,并对术中内脏牵拉反应状况进行评估。结果与观察组比较,手术牵拉结肠时(T3)对照组SBP、DBP指标明显升高(P<0.05)。结论在硬膜外阻滞效果确切的前提下,辅助小剂量瑞芬太尼(0.05～0.1)μg/(kg.min)持续输注,可有效抑制结肠手术术中牵拉反应,既达到良好的镇痛、镇静效果,又能维持患者的呼吸循环稳定和术中清醒,值得临床应用。

Constant infusions of small-doses remifentanil during epidural anesthesia for prevent the visceral traction reaction induced by colonic operation

Objective To evaluate the effect of small-doses remifentanil in preventing colonic operation induced visceral traction reaction during epidural anesthesia. Methods Sixty patients scheduled for colonic operation were divided into ob- servation group and control group randomly （n = 30）. After epidural puncture at thoracic 11-12 vertebral clearance success- fully, 6-15 mL 0.5% ropivacaine was injected into epidural space. Before skin incision, the observation group received in- travenous infusion of remifentanil 0.1 p~g/（kg-min）] until abdomen-closing, and the control group received not any treatment. The SBP, DBP, HR, and SpO2 were recorded before anesthesia（Tl ）, before opening the abdominal cavity （T2）, at the mo- ment of the colon was tractated （T3）, and the end of operation（T4）. The visceral traction reaction was 1 recorded during operation as well. Results Compared with the observation group, the SBP, DBP higher in the control group significantly at T3 time-point. Conclusion Under the condition of satisfactory anesthesia, constant infusions of small-doses remifentanil during epidural anesthesia can effectively suppress the colonic operation induced visceral traction reaction. The method not only produces a satisfactory analgesic effect, but the condition of consciousness, respiration and circulatinn is stable as well.