摘要
目的 研究瑞芬太尼、氯诺昔康单独或联合应用于全麻患者能否在苏醒期清醒、无痛拔管。方法 选取颌面部手术患者60例，美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，随机分为4组（n=15）。Ⅰ组，术毕停用瑞芬太尼；Ⅱ组，术毕瑞芬太尼减量至0．05μg/（kg·min），拔管后即停药；Ⅲ组，诱导前20min、术毕前30min分别静注氯诺昔康8mg，瑞芬太尼术毕即停药；Ⅳ组，诱导前20min、术毕前30min分别静注氯诺昔康8mg，术毕瑞芬太尼减量至0，05μg（kg·min），拔管后即停药。观察记录患者苏醒期有无呛咳、躁动，呼唤睁眼时间、拔管时间，术毕、拔管即刻、拔管后5、10min血压（BP）、心率（HR），拔管后5、10min疼痛评分采用语言评价量表（VRs）。结果Ⅱ、Ⅳ组患者呛咳发生率均明显低于Ⅰ组（P〈0．05），睁眼时间和拔管时间均比Ⅰ组稍延长（P〈0．05）。Ⅱ、Ⅲ和Ⅳ组拔管即刻、拔管后5rainBP和HR均低于Ⅰ组（P〈0.05或P〈0.01），Ⅲ组和Ⅳ组在拔管后10minBP和HR仍低于Ⅰ组（P〈0．05或P〈0．01），Ⅳ组患者各时间点的BP、HR无明显差异（P〉0．05）。Ⅱ、Ⅲ和Ⅳ组拔管后5minVRS评分均低于Ⅰ组（P〈0．05）。Ⅲ组和Ⅳ组拔管后10minVRS评分低于Ⅰ组或Ⅱ组（P〈0．05或P〈0．01）。结论瑞芬太尼或氯诺昔康单独应用均可降低全麻苏醒期不良反应；二者联合应用可在患者清醒、无痛条件下安全拔管。
Objective To study the efficacy of remifentanil or/and lornoxicam in reducing the adverse effects during recovery from general anesthesia. Methods Sixty ASA Ⅰ to Ⅱ patients aged 18 to 60 years who experienced oral or maxillofaeial operations, were divided into four groups（ n = 15） ： group Ⅰ （remifentanil infusion was stopped at the end of the operations）, group Ⅱ （remifentanil infusion turned into 0. 05μg/（ kg· min） after the completion of the operations and remained till extubation）, group m （8 mg was intravenously administered at 20 min before introduction and 30 min before the completion of the operation）, and group Ⅳ（ remifentanil was used as group Ⅱ and lornoxicam was used as group Ⅲ ）. Anesthetic induction and maintenacnce were the same in the four groups. The rate of restlessness and cough during recovery, the time of opening eyes when called, the time of extubation, blood pressure （BP）, heart rate （HR） at completion of the operations, extubation, and 5 and 10min after extubation, and the scores of verbal rating scale （VRS） at 5 and 10 min after extubation were determined. Results The cough rate in groups Ⅱ and Ⅳ was lower than that in group Ⅰ （ P 〈 0. 05 ）, the times of opening eyes and of extubation were also longer than those in group Ⅰ （ P 〈 0. 05）. The BP and HR in groups Ⅱ , Ⅲ and Ⅳ were significantly lower than those in group Ⅰ at extubation and 5 min after extubation （ P 〈 0. 05 or P 〈 0. 01 ）, also they were lower in groups Ⅲ and Ⅳ than in groups Ⅰ at 10 min after extubation （P〈0.05 or P〈0.01）, but they were steady in group Ⅳ during the recovery. Tne VRS scores were remarkably lower in group Ⅱ , Ⅲ and Ⅳ than in group Ⅰ at 5 min after extubation（ P 〈 0.05） and were significantly lowerin group Ⅲ and Ⅳ thanin group Ⅰ and Ⅱ at 10 min after extubafion（P〈0.05）. Conclusion Administered remifentanil or lomoxicam can reduce adverse effects during recovery from general anesthesia, and their combination makes extubation comfortable, painless and safe.
出处
《山东大学学报（医学版）》
CAS
北大核心
2008年第1期104-107,共4页
Journal of Shandong University:Health Sciences
关键词
瑞芬太尼
氯诺昔康
全麻
疼痛
拔管
Remifentanil
Lomoxicam
General anesthesia
Pain
Extubation
