摘要
目的:评价瑞芬太尼对全麻术后气管拔管血压、血糖和皮质醇的影响。方法:60例气管插管全麻下手术病人,随机分为5组,每组12例。气管拔管前静脉注射药物,Ⅰ组予氯化钠注射液10 mL,Ⅱ组予瑞芬太尼0．25μg·kg^(-1),Ⅲ组予瑞芬太尼0．5μg·kg^(-1),Ⅳ组予瑞芬太尼0．75μg·kg^(-1),Ⅴ组予艾司洛尔1．5 mg·kg^(-1),给药时间大于30 s。分别在拔管前,拔管即刻,拔管后2、5、10 min,检测病人血糖、皮质醇浓度同时记录以上各点的血压和心率。结果:与拔管前比较,拔管后Ⅰ组心率和血压明显升高(P＜0．01);Ⅱ组血压无显著变化,心率升高明显(P＜0．01);Ⅲ,Ⅳ和Ⅴ组血压与心率均下降。与Ⅰ组比较,Ⅱ组各时点收缩压较平稳,舒张压和心率变化组间无显著差异。Ⅲ,Ⅳ和Ⅴ组拔管即刻收缩压和心率明显降低,幅度均大于Ⅰ和Ⅱ组(P＜0．05)。各组病人拔管后的血糖均比拔管前有所升高(P＜0．05),与Ⅰ和Ⅱ组比较,Ⅲ和Ⅳ组血糖升高幅度较小,拔管即刻Ⅲ组血糖低于Ⅰ和Ⅱ组(P＜0．05)。拔管后Ⅰ组皮质醇升高明显(P＜0．05),其余组变化较小。Ⅰ组发生呛咳4例,高于Ⅲ组和Ⅳ组(均无,P＜0．05),与Ⅴ组相似(3例)。Ⅳ组发生嗜睡6例,呼吸抑制4例。结论:拔管前静脉注射瑞芬太尼能有效抑制气管拔管引起的血压和心率变化及血糖、皮质醇的升高,效果优于艾司洛尔,0．5μg·kg^(-1)的剂量效果好且不良反应少。
AIM： To evaluate the effects of remifentanil on blood pressure, blood glucose and cortisol at extubation after general anaesthesia. METHODS ： Sixty ASA Ⅰ - Ⅱ patients undergoing elective operation under general anesthesia were randomly divided into 5 groups with twelve patients in each group. Group Ⅰ received 0.9 % sodium chloride injection 10 mL iv, group Ⅱ remifentanil 0.25 μg·kg^-1 iv, group Ⅲ remifentanil 0.5 μg·kg^-1 iv, group Ⅳ remifentanil 0.75 μg·kg^-1 iv, and group Ⅴ esmolol 1.5 mg·kg^-1 iv. All the dosages and time （〉 30 s） were designated for individual in the five groups. The blood samples were taken before extubation, at extubation and 2, 5, 10 min after extubation for determination of plasma cortisol and blood glucose, and recorded the changes of blood pressure and heart rate. RESULTS： In group Ⅰ , blood pressure, heart rate significantly increased after extubation （P 〈 0.01 ）. Blood pressure showed no significant increase but heart rate increased significantly in group Ⅱ（P 〈 0.01 ）. There were significant decrease of blood pressure and heart rate in group Ⅲ, Ⅳ and Ⅴ . Comparing with group Ⅰ , there were no significant differences in diastolic blood pressure and heart rate at extubation, but with stable systolic blood pressure in group Ⅱ. There were significant decrease of systolic blood pressure and heart rate at extubation in group Ⅲ, Ⅳ and Ⅴ, more than those of group Ⅰ and Ⅱ （P 〈 0.05 ）. There were significant increase in blood glucose at extubation and 2, 5, 10 min after extubation in each group （P 〈 0.05）. Comparing with group Ⅰ and Ⅱ , glucose increased less in group Ⅲ and Ⅳ ; glucose of group m was lower than those of group Ⅰ and Ⅱ at extubation （P 〈 0.05）. Cortisol increased significantly after extubation in group Ⅰ , but increased less in other groups. Four patients with bucking occurred in group Ⅰ , significantly higher than those of group Ⅲ and Ⅳ （P 〈 0.05）, but similar to group Ⅴ （3 patients）. Six patients with lethargy and 4 patients with respiratory depression occurred in group Ⅳ CONCLUSION： Remifentanil intravenous injection before extubation can attenuate the responses to tracheal extubation with more efficiency than esmolol, and the dose of 0.5 μg·kg^-1 seems to be the perfect one.
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2007年第3期229-233,共5页
Chinese Journal of New Drugs and Clinical Remedies
关键词
瑞芬太尼
麻醉
血压
血糖
氢化可的松
remifentanil
anaesthesia
blood pressure
glucose
hydrocortisone
